Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause?
Aims. We investigated the histopathological features of solitary pulmonary necrotic nodules (NNs) of undetermined cause. We combined our findings with those obtained using other methods to determine how well the etiological factors were explained. Methods. We screened patients who underwent surgery...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Canadian Respiratory Journal |
| Online Access: | http://dx.doi.org/10.1155/2020/7850750 |
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| author | Halide Nur Urer Mehmet Zeki Gunluoglu Nurcan Unver Sezer Toprak Mediha Gonenc Ortakoylu |
| author_facet | Halide Nur Urer Mehmet Zeki Gunluoglu Nurcan Unver Sezer Toprak Mediha Gonenc Ortakoylu |
| author_sort | Halide Nur Urer |
| collection | DOAJ |
| description | Aims. We investigated the histopathological features of solitary pulmonary necrotic nodules (NNs) of undetermined cause. We combined our findings with those obtained using other methods to determine how well the etiological factors were explained. Methods. We screened patients who underwent surgery to treat solitary pulmonary granulomatous and nongranulomatous NNs of undetermined cause. The NN sizes and features of both the NNs and adjacent parenchyma were evaluated. Histochemical analyses included Ehrlich–Ziehl–Neelsen (EZN), Grocott, and Gram staining. Polymerase chain reaction (PCR) was used to detect tuberculous and nontuberculous mycobacteria, panfungal DNA, Nocardia, Francisella tularensis types A and B, and actinomycetes. Results. The NNs were granulomatous in 78.9% and nongranulomatous in 21% of the 114 patients included. EZN staining or PCR was positive for Mycobacterium in 53.5% of all NNs: 62.2% of granulomatous and 20.8% of nongranulomatous NNs. We found a weak but significant correlation between granulomatous NNs and Bacillus positivity and a significant correlation between granulomas surrounding the NNs and the presence of multiple necroses. The NN etiology was determined via histopathological, histochemical, and PCR analyses in 57% of patients but remained undetermined in 42.9%. Conclusion. The causes of both granulomatous and nongranulomatous NNs can be determined by pathological examination. Granulomatous necrosis and granulomas in the adjacent parenchyma are important for differential diagnosis. When both features are present, they strongly support a diagnosis of tuberculosis, even in the absence of bacilli. |
| format | Article |
| id | doaj-art-61db3ce272eb46a29c577fda532efff6 |
| institution | OA Journals |
| issn | 1198-2241 1916-7245 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Respiratory Journal |
| spelling | doaj-art-61db3ce272eb46a29c577fda532efff62025-08-20T02:35:22ZengWileyCanadian Respiratory Journal1198-22411916-72452020-01-01202010.1155/2020/78507507850750Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause?Halide Nur Urer0Mehmet Zeki Gunluoglu1Nurcan Unver2Sezer Toprak3Mediha Gonenc Ortakoylu4University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pathology, Istanbul, TurkeyMedipol University School of Medicine, Thoracic Surgery, Istanbul, TurkeyUniversity of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pathology, Istanbul, TurkeyUniversity of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Microbiology, Istanbul, TurkeyUniversity of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Medicine, Istanbul, TurkeyAims. We investigated the histopathological features of solitary pulmonary necrotic nodules (NNs) of undetermined cause. We combined our findings with those obtained using other methods to determine how well the etiological factors were explained. Methods. We screened patients who underwent surgery to treat solitary pulmonary granulomatous and nongranulomatous NNs of undetermined cause. The NN sizes and features of both the NNs and adjacent parenchyma were evaluated. Histochemical analyses included Ehrlich–Ziehl–Neelsen (EZN), Grocott, and Gram staining. Polymerase chain reaction (PCR) was used to detect tuberculous and nontuberculous mycobacteria, panfungal DNA, Nocardia, Francisella tularensis types A and B, and actinomycetes. Results. The NNs were granulomatous in 78.9% and nongranulomatous in 21% of the 114 patients included. EZN staining or PCR was positive for Mycobacterium in 53.5% of all NNs: 62.2% of granulomatous and 20.8% of nongranulomatous NNs. We found a weak but significant correlation between granulomatous NNs and Bacillus positivity and a significant correlation between granulomas surrounding the NNs and the presence of multiple necroses. The NN etiology was determined via histopathological, histochemical, and PCR analyses in 57% of patients but remained undetermined in 42.9%. Conclusion. The causes of both granulomatous and nongranulomatous NNs can be determined by pathological examination. Granulomatous necrosis and granulomas in the adjacent parenchyma are important for differential diagnosis. When both features are present, they strongly support a diagnosis of tuberculosis, even in the absence of bacilli.http://dx.doi.org/10.1155/2020/7850750 |
| spellingShingle | Halide Nur Urer Mehmet Zeki Gunluoglu Nurcan Unver Sezer Toprak Mediha Gonenc Ortakoylu Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause? Canadian Respiratory Journal |
| title | Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause? |
| title_full | Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause? |
| title_fullStr | Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause? |
| title_full_unstemmed | Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause? |
| title_short | Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause? |
| title_sort | benign solitary pulmonary necrotic nodules how effectively does pathological examination explain the cause |
| url | http://dx.doi.org/10.1155/2020/7850750 |
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