Pulmonary granular cell tumors are rare lesions, with approximately 100 reported cases in the literature. We present a case of pulmonary granular cell tumor. A 21-year-old female was admitted to our hospital with a long history of chronic coughing. The computed tomography scan of the thorax showed an infiltrate in the anterior segment of the right lower lobe. The flexible bronchoscopy revealed infiltration at the entrance of the right lower lobe bronchus. The bronchoscopic biopsy revealed the diagnosis of granular cell tumor. She under-went a right lower lobectomy. Forty-two months after surgery, the patient remains disease-free and there has been no recurrence of the tumor.

Lung cancer is one of the most common causes of cancer deaths worldwide and at diagnosis approximately 50% of the patients have distant metastases. However, symptomatic colon metastasis of primary lung adenocarcinoma is very rare. Immunohistochemical staining is valuable in the differential diagnosis of lung cancer. Lung adenocarcinomas are generally positive for cytokeratin-7 (CK-7) staining and negative for cytokeratin-20 (CK-20) staining. On the other hand, lung metastases of colorectal adenocarcinomas are generally negative for CK-7 staining and positive for CK-20 staining. The prognosis of lung cancer patients with gastrointestinal involvement is poor and the average survival time is from four to eight weeks. The differential diagnosis of colorectal tumors as primary or metastasis, in patients with lung cancer, is important in terms of treatment strategy.

Vitamin D is converted into its active metabolites by sunlight. Several illnesses may occur when the serum level of Vitamin D is decreased. The association between tuberculosis and sunlight has been known for hundreds of years, and sunlight was the first method used for the treatment of tuberculosis. Fatigue is often an early complaint of Vitamin D deficiency. We found Vitamin D deficiency in one patient who was initiated on an anti-tuberculosis treatment following a diagnosis of tuberculosis on her persistent complaint of fatigue. The Severity of Fatigue Scale was used to evaluate pre- and post-treatment fatigue scores for Vitamin D therapy, indicating an improvement in the severity of fatigue following the treatment. We believe that the assessment of fatigue, which is usually underestimated by patients and healthcare professionals a like, is probably due to the lack of any attempt to measure it, but would contribute to the evaluation of the treatment response.

Smallpox pneumonia is a rare complication of the smallpox infection. We present our case of required mechanical ventilation related to smallpox pneumonia in association with respiration failure. A 31-year-old female applied to our emergency department due to cough, tachypnea, and a common papulovesicular skin rash as her radiological investigations bilateral nodular pulmonary infiltrates were diagnosed. She had a contact history, with her baby experiencing the smallpox disease. According to clinical and laboratory findings the case was diagnosed as smallpox pneumonia. Acyclovir 4 gr/day p.o. antiviral management was initiated. At the second day severe dyspnea and cyanoses occurred and patient transferred to intensive care unit after intubation. After 48 hours with mechanical ventilation the patient extubated herself. After 15 days of acyclovir treatment a remarkable clinical and radiological recovery was observed. During smallpox disease symptoms of pneumonia and also possible hypoxemia must be closely monitored in order to prevent mortality due to respiratory failure.

Lipoid pneumonia is a rare form of pneumonia. There are two types; exogenous and endogenous. The exogenous form often occurs due to accidental aspiration of fatty substances (such as; animal, vegetable or mineral fats). For elderly patients inparticular, the most common causes are oily nose drops and the use of oily substances for laxatives, such as castor oil. They are compounds containing hydrocarbons and hydrogen. The most common example is the oil found in paraffin, olefins, aromatics and the the acetylene series. Aspiration of high viscosity petroleum hydrocarbons may cause lipoid pneumonia. The accidental aspiration of hydrocarbon compounds can also cause acute illnesses such as fire eaters' pneumonia. In particular, the storing of hydrocarbon compounds in inappropriate packaging in the home, such as water, fruit juice or carbonated beverage bottles, are important factors facilitating the accidental drinking of these compounds by children. Since it does not have any specific clinic and radiological finding, it may be difficult to diagnose it, unless there is strong suspicion, or data is derived from anamnesis. Though a more common form of serious poisoning in childhood, in this study we, present two cases of lipoid pneumonia, diagnosed in adults.

Hypersensitivity pneumonitis is a chronic inflammatory disease that represents one possible response of the interstitial and paranchimal tissue to the intensive and repeated inhalation of antigenic substances. It was rarely seen and overlooked many times because of the different clinical symptoms. The most important point in the diagnosis is to consider HP and to profoundly question the environmental and occupational exposure. We present three women, four men (mean age 32) 7 HP cases who applied to our clinic with different pre-diagnosis and were diagnosed with HP, as a result of the examinations, and started treatment, receiving follow-up in the light of the literature.

Sarcoidosis, is a multisystem disease with unknown etiology and non-caseating epithelioid granulomas and fibrosis. Skin involvement occurs up to 9-37% of patients and may present at any stage of the disease. The most common maculopapular cutaneous lesions is experienced in sarcoidosis and although rarely also monitored in other forms of skin lesions. In this study, a patient diagnosed with sarcoidosis with psoriasis-like skin lesions has been discussed.

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis, characterized by asthma, eosinophilia and extravascular granulomas. It can affect anyone at any age; however, it is most commonly seen in patients aged between 38 and 50. In this paper, we report a case of CSS presenting in advanced age. A 77-year-old male patient was referred our hospital because his pneumonia had not responded to treatment for three weeks. He had history of asthma for four years and his breathlessness was aggravated in the previous three months. He was twice hospitalized with asthma and pneumonia. Migratory consolidations were seen on the chest x-ray when compared with the previous four months graphics. Patchy consolidation areas were seen on the thorax-computed tomography (CT). Eosinophilia was detected in bronchoalveolar lavage. Chronic sinusitis was seen on a paranasal CT and mononeuritis multiplex was detected using electromyography. The patient was diagnosed as CSS according to the criteria of the American Rheumatology Committee. Clinical, radiological and laboratory findings were significantly recovered with corticosteroid treatment.

Cases of bronchial carcinoid tumors and tumorlets are lung neuroendocrine-based tumors are rarely seen. Diffuse idiopathic neuroendocrin cell hyperplasia, tumorlet and carcinoid tumors are similar to each other. It is also not clear which one initiates the other, despite the fact that we could see both these entities together. Since diffuse idiopathic neuroendocrin cell hyperplasia can be seen as progressive fibrosis, this case can be evaluated as interstitial lung disease. In this article, a diffuse interstitial lung disease examination for a 55-year-old woman showed us no result radiologically but in bronchoscopy, a randomly determined carcinoid tumor-tumorlet case was presented. Patients that have diffused interstitial lung disease findings may have both diffuse idiopathic neuroendocrin cell hyperplasia and carcinoid tumorlet. We want to point out that in these cases bronchoscopy can diagnose the disease more accurately.

Although foreign body aspiration is not common in adults, they usually present with different clinical signs and symptoms. Although cough, wheeze, stridor, or hemoptysis is the presenting symptoms, it can mimic other clinical entities in late presentations. This causes problematic and late diagnosis. Radiological investigations may help to confirm aspiration but should not be used to exclude it. Rigid bronchoscopy can be applied for both diagnosis and treatment in these cases. Three cases of foreign body aspiration with different clinics are presented in light of literature.

In adults, lipoma is a common benign tumor of soft tissues, composed of adipose tissue and occasionally fibrous stroma. An intrathoracic location, particularly in the parietal pleura, is rare. Since most of the patients have no symptoms at the time of diagnosis, it is usually diagnosed incidentally with pulmonary radiography for other indications. It is possible to make a diagnosis of lipoma by computed tomography (CT) and magnetic resonance imaging (MRI). Since lipomas have fat attenuation, diagnosis with CT is made with density measurements and MRI may also be useful for further characterization of these lesions. We report radiological findings of a pleural lipoma case with the review of the literature.

Mounier-Kuhn syndrome (MKS) is a syndrome characterized by the expansion of the trachea-bronchus, recurrent respiratory tract infections, and bronchiectasis. Herein, two cases were presented with MKS, as a rare disease. For years, cases had been followed up as asthma/chronic-obstructive-pulmonary-disease. In the radiological examinations of cases, there were bronchiectasic areas, and the growth of rare bacteria in bronchial secretions. The two women were diagnosed as MKS when they were 43 and 63-yrs-old respectively, with severe enlargement of the tracheal and main bronchus diameter in the thoracic radiology. A tracheal stent was placed in case-1, and although her symptoms were relieved, we stopped trying the procedure because of the recurrent displacement of the stent caused by hemoptysis. Case-2 had polycythemia with no hypoxemia. Both cases were given supportive therapy including bronchodilator, mucolytic, prophylactic antibiotic to control infection and vaccine immunization. As a result MKS should be kept in mind in the distinctive diagnosis of treatment resistant bronchospasm.

Scimitar syndrome or pulmonary venolabar syndrome is a rare congenital anomalous pulmonary venous return. A 47-year-old woman presented at our clinic with chest pain and shortness of breath during exertion. The physical examination and laboratory findings were normal. The chest radiograph demonstra-ted non-homogeneous increased opacity along the right cardiac border, and volume loss of the right lung with cardiac silhouette displacement, to the right. Echocardiography pulmonary artery systolic pressure was measured as 55 mmHg. Fiberoptic bronchoscopy revealed the intermediate bronchus was absent. On magnetic resonance angiography, it was observed that the right pulmonary veins drained into the inferior vena cava at a subdiaphragmatic level, consistent with Scimitar Syndrome. The case, diagnosed as Scimitar syndrome, is presented in the light of the literature.

Multiple primary lung cancers are unusual but important to identify, since the therapy protocol and the prognosis will be different when compare with metastatic tumors. We present the case of a 64-year-old man with synchronous lung tumors of different histopathological patterns in the same lobe. Radiological investigation revealed two areas of high-intensity fludeoxyglucose uptake of varying size within the left upper lobe. He underwent left upper lobectomy. Histological analysis confirmed these lesions as adenocarcinoma and moderately differentiated squamous cell carcinoma.

Tracheobronchial rupture is a rare but life-threatening injury encountered after blunt chest traumas. It is especially seen in pediatric patients because of the complete conduction of traumatic kinetic energy and the direct exposure to the airway, due to the increased elasticity of the chest wall and other anatomical structures. We report the case of an eight-year-old boy, who presented with right-sided pneumothorax, following blunt chest trauma. He deteriorated despite a thoracic drain and, during the emergency thoracotomy was finally diagnosed with a main bronchial rupture, and was treated with isolated end-to-end bronchial anastomosis. The repair of right main bronchial rupture was performed with complete preservation of the right lung; the boy was discharged from the hospital on postoperative day 10, and was followed up asymptomatically for the following 32 months. This rare thoracic surgery case of pediatric patients is discussed in light of recent literature for diagnosis and surgical management.

The posterior mediastinum is an atypical localization for thyroid tumors. The incidence of mediastinal goiter varies from 0.16% to 3.3% in thyroid tumors. Symptoms related to tumor size and its relationship with surrounding tissues may appear. Neuropathic pain is an extremely rare finding caused by an ectopic thyroid. We present here a 42-year-old male patient suffering from neuropathic pain in his back. Thoracic computed tomography and magnetic resonance imaging showed a smooth-bordered mass approximately 8x10 cm in size located in the paravertebral sulcus and compressing both the trachea and the esophagus. The tumor was diagnosed as ectopic thyroid and completely resected through a thoracotomy, with relief of pain postoperatively.

Lipomas consisting of mature fat cells are soft, slow-growing, benign, indolent tumors. Despite appearing in all age groups, lipomas are usually seen in women between 40 and 60 years of age. Lipomas are easily detected by physical examination and often do not require treatment. Lipomas can settle in all parts of the body where there is fat, but they are rare in the head and neck region. The most common location in head and neck region is the posterior cervical triangle. Lipomas are in the form well-defined radiolucent mass on plain radiography. In addition, lipomas are well circumscribed, elliptical-oval, the long axis parallel to the skin surface, contains echogenic lines on ultrasound, In computed tomography, their densitometric measurements are determined, minus the value in the Hounsfield Unit scale. Heterogeneous appearance of the lesion is a sign of liposarcoma. Superficial small, simple lipomas are rarely reach very large sizes. In the literature, the neck localized giant lipoma has only rarely been reported. In our study, presented a giant lipoma localized to the cervical region along with literature.

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