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Cryptococcus gattii is an endemic fungus predominantly isolated in the tropical and subtropical regions, causing predominantly pulmonary disease with a predilection for the central nervous system. Herein, we report a case of rapidly progressing C. gattii pneumonia in an immune-deficient but virologically suppressed host with underlying human immunodeficiency viral (HIV) infection, exhibiting various fungal morphologies from bronchoalveolar lavage (BAL) cytological specimens. A 51-year-old Chinese male with known HIV disease was admitted to the Singapore General Hospital for evaluation of functional decline, febrile episodes, and a left hilar mass on chest radiograph. Computed tomography (CT) showed consolidation in the apical segment of the left lower lobe. He underwent bronchoscopy and BAL. Positron emission tomography-computed tomography done 10 days after the initial CT showed approximate doubling of the pulmonary lesion. Cytological examination of the fluid revealed yeasts of varying sizes. Subsequent fungal culture from BAL fluid grew C. gattii 10 days later.

A left lung mass after induction and tracheal intubation, which partially was obstructing the left main bronchus, was accidentally discovered in a 56-year-old female scheduled to undergo elective total thyroidectomy. Her preoperative chest X-ray showed a right-sided shift of the trachea. She did not have stridor or shortness of breath or superior vena cava obstructive syndrome. Induction and tracheal intubation were performed uneventfully. Fiberoptic bronchoscopy performed and showed complete obstruction on the left main bronchus. Excision biopsy suggested mucoepidermoid carcinoma (MEC). MEC is one of the very rare neoplasms of the lungs. Most lesions are low grade and overall prognosis may be more favorable than other forms of lung cancer.

Objectives The exploration of how dysbiosis relates to lung masses is still nascent, with few studies focusing on the microbial characteristics across various sites. Therefore, we categorized the microbiota into feces and bronchoalveolar fluid (BALF) groups to compare microbial characteristics between benign and malignant masses, analyze their clinical correlations, and develop predictive models for lung cancer. Methods A total of 238 fecal samples and 34 BALF samples were collected from patients with benign and malignant masses and then analyzed by 16 SrRNA. We explored the distinct composition of the gut and lung microbiota and their associations with clinical features. The diagnostic models were constructed using microbial features identified through two approaches: random forest algorithm with five-fold cross-validation and comparative analysis of significantly differential taxa. The performance evaluation was subsequently conducted using receiver operating characteristic (ROC) analysis. Results There was no significant difference in α-and β-diversity between feces and BALF groups. The relative abundance of Lachnospiraceae_NK4A136_group ( P  = 0.003232) and Erysipelotrichaceae_UCG-003 ( P  = 0.01316) in feces group and Proteobacteria ( P  = 0.03654) in BALF group were significantly increased in lung cancer patients. We also found Bacteroides ( P  = 0.01458) was abundant in NSCLC than those of SCLC in feces group, while the BALF group was dominated by norank_c_Cyanobacteria ( P  = 0.03384). Smoking history appeared to be related to the distribution of microbiota, with enrichment of Parabacteroides ( P  = 0.02054) in feces and Prevotella_1 ( P  = 0.03286) in BALF. Furthermore, the patients with Sellimonas ( P  = 0.04148) in feces and Alloprevotella ( P  = 0.04283) in BALF seemed to have better response to chemotherapy combined with immunotherapy. For differentiating benign and malignant masses, the combination of Megasphaera and norank_p__Saccharibacteria in BALF demonstrated superior predictive performance, with an AUC reaching 0.8 (95% CI 0.59-1). Conclusion The microbiota composition significantly differed between benign and malignant masses in both fecal and BALF groups, with minimal evidence supporting microbial migration between these two sites. Our findings suggest that BALF microbiota may serve as a more reliable biomarker for lung masses classification, offering valuable insights for early diagnosis and clinical decision-making.

Primary pediatric lung tumors are uncommon and have many overlapping clinical and imaging features. In contrast to adult lung tumors, these rare pediatric neoplasms have a relatively broad histologic spectrum. Informed by a single-institution 13-year retrospective record review, we present an overview of the most common primary pediatric lung neoplasms, with a focus on the role of positron emission tomography (PET), specifically 18F-fluorodeoxyglucose (FDG) PET and 68Ga-DOTATATE PET, in the management of primary pediatric lung tumors. In addition to characteristic conventional radiographic and cross-sectional imaging findings, knowledge of patient age, underlying cancer predisposition syndromes, and PET imaging features may help narrow the differential. While metastases from other primary malignancies remain the most commonly encountered pediatric lung malignancy, the examples presented in this pictorial essay highlight many of the important conventional radiologic and PET imaging features of primary pediatric lung malignancies.

Background Behçet’s disease (BD) is a multisystem inflammatory disorder that can affect various organs, including the lungs. Pulmonary manifestations are rare and typically present as pulmonary artery aneurysms. Case presentation We report the case of a 56-year-old East Asian male with a 27-year history of BD, who had no respiratory symptoms, such as hemoptysis, cough, or fever. Chest imaging revealed lymph node enlargement and a lung mass, initially raising concerns of malignancy. Despite the suspicious radiological findings, three biopsies, including a surgical biopsy, were all negative for malignancy. Remarkably, over the course of 2 years, these pulmonary manifestations spontaneously regressed without any specific treatment for lung involvement, and the patient remained in a stable BD state. Conclusions BD patients are at an increased risk for malignancy compared to healthy controls, making it crucial to differentiate between malignancy and BD-related pulmonary abnormalities. This case highlights that, in the absence of active BD symptoms, lymphadenopathy and lung masses can occur and may resolve spontaneously. Accurate diagnosis and vigilant monitoring are essential in BD patients but BD-related lung involvement should be considered in similar cases.

Primary pulmonary lung cancer is rare in dogs, and clinicians increasingly rely on advanced imaging for diagnosis and treatment planning. However, manual lesion segmentation can be time-consuming and subject to operator variability. This retrospective study compiled a multicenter dataset of canine CT scans containing at least one pulmonary mass measuring more than 2 cm. Data were collected from two university veterinary hospitals and a teleradiology service, encompassing varying acquisition protocols and scanner types. Lesions were manually segmented to create ground truth masks, and an AI model was trained and evaluated using the nnUNet v2 framework with a 5-fold cross-validation approach. Performance on a separate test set of 30 scans was quantified using the Dice Similarity Coefficient (DSC) and Average Symmetric Surface Distance (ASSD). The databse was made of 217 cases. The training/validation set comprised 187 cases. The model's segmentation accuracy was tested on 30 cases. The trained model had a high segmentation accuracy on the test set, with a mean DSC of 0.91 and an ASSD of 1.88 mm. The model had high performance on homogeneous, well-defined masses, whereas the presence of intralesional mineralisation or pleural effusion had a negative impact on the model's performance.

Background The correlation between central airway anatomical parameters and demographic factors, such as sex, age, weight, height, body mass index (BMI), and cardiac factors, remains unclear. This study examined the correlation between these factors and central airway anatomical parameters in adult patients. Methods All consecutive patients who underwent lung mass surgery at our hospital between December 2020 and December 2023 were included in this study. DeepInsight software was used to analyze high-resolution chest computed tomography (HRCT) images and to measure various central airway anatomical parameters, including tracheal diameter (TD), tracheal length (TL), left main bronchus diameter (LBD), left main bronchus length (LBL), right main bronchus diameter (RBD), right main bronchus length (RBL), and subcarinal angle (SCA). A multivariate linear regression analysis was performed to evaluate the independent effects of sex, age, weight, height, BMI, left atrial diameter, and diastolic left ventricular internal diameter (LVIDd) on these anatomical parameters. Results Among the 391 patients included in this study, all were over 18 years old, with 192 male and 199 female. The multivariate linear regression analysis indicated that in male patients with lung masses, TD exhibited a negative correlation with age (β =  − 0.032, P  = 0.015) and a positive correlation with height (β = 0.099, P  < 0.001). Furthermore, TL exhibited a positive correlation with height (β = 0.311, P  = 0.004). LBL was substantially influenced by age (β =  − 0.098, P  = 0.011), height (β = 0.204, P  = 0.003), and BMI (β = 0.311, P  = 0.026). Conversely, RBD exhibited notable correlations with height (β = 0.062, P  = 0.02), BMI (β =  − 0.113, P  = 0.039), and left atrial size (β = 0.111, P  = 0.007). In female patients, TD and TL exhibited positive correlations with height (β = 0.065, P  = 0.01; β = 0.337, P  = 0.01, respectively). LBL was significantly correlated only with height (β = 0.171, P  = 0.045), whereas LBD exhibited an inverse correlation with age (β =  − 0.024, P  = 0.014). In addition, changes in SCA were positively associated with left atrial size (β = 0.65, P  = 0.042), indicating a potential anatomical correlation. Conclusion This study innovatively examined the impact of cardiac factors on central airway anatomical parameters in adult patients with lung masses. Notably, age, as an important factor in airway development, was found to have significant associations with tracheal characteristics along with height in males, while tracheal features exhibited a particularly strong relationship with height in females. Furthermore, the study identified associations between right bronchial diameter (RBD) in males and subcarinal angle (SCA) in females with left atrial size, although these findings require further validation in larger and more diverse populations.

Background Immunoglobulin G4-related disease (IgG4-RD) is characterized by the formation of inflammatory lesions with fibrosis and infiltration of IgG4-positive plasma cells and lymphocytes in various organs of the body. Since the first report of IgG4-related autoimmune pancreatitis, IgG4-RD affecting various organs has been reported; however, only a few reports of IgG4-related lung disease (IgG4-RLD) exist. In this report, we describe a case of IgG4-RLD that was difficult to differentiate from malignancy, and the usefulness of the surgical approach in determining the appropriate diagnosis and treatment plan. Case presentation A 61-year-old man was referred to our hospital after a chest radiograph revealed an abnormal chest shadow. At the time of his first visit, he had a slight fever and dyspnea on exertion. Chest computed tomography (CT) revealed a middle lobe hilar mass with irregular margins and swelling of the right hilar and mediastinal lymph nodes. These findings were not present on CT 1.5 years ago. 18 F-fluorodeoxyglucose-positron emission tomography revealed a mass lesion with a maximum diameter of 5.5 cm, maximum standardized uptake value (SUVmax) of 11.0, and areas with high SUV in the hilar and mediastinal lymph nodes. We suspected lung cancer or malignant lymphoma and performed a thoracoscopic lung biopsy to confirm the diagnosis. Histopathological examination revealed no malignant findings, and IgG4-RLD was diagnosed. One month after treatment with prednisolone (PSL), the tumor had shrunk, but a CT scan during the third month of PSL treatment revealed multiple nodular shadows in both lungs. Considering the possibility of malignant complications and multiple lung metastases, we performed thoracoscopic partial lung resection of the new left lung nodules to determine the treatment strategy. Histopathological examination revealed no malignant findings in any of the lesions, and the patient was diagnosed with IgG4-RLD refractory to PSL monotherapy. Conclusions IgG4-RLD refractory to PSL monotherapy showed changes from a solitary large mass (pseudotumor) to multiple nodules on chest CT. It was difficult to distinguish malignancy from IgG4-RLD based on imaging tests and blood samples alone, and the surgical approach was useful in determining the appropriate diagnosis and treatment plan.

Objective: Vasculitis is an increasingly prevalent condition, often characterised by an insidious and multifaceted clinical course, which delays accurate diagnosis and treatment. Case Report: A 63-year-old male diagnosed with granulomatosis with polyangiitis (GPA), who demonstrated pulmonary disease progression after six months of remission-induction therapy with cyclophosphamide. Imaging studies revealed new cavitating infiltrates in the upper lobe of the left lung, along with numerous satellite nodules in both lungs. A thorough differential diagnosis ruled out infectious aetiologies. Conclusions: Despite extensive diagnostic efforts, including invasive procedures and positron emission tomography–computed tomography scanning, exclusion of malignancy remained challenging. Establishing an accurate diagnosis and excluding infectious or neoplastic diseases enables timely and appropriate treatment, which can be life-saving in patients with GPA. Delayed treatment increases the risk of GPA-related organ complications.

ABSTRACT Synovial sarcoma is one of the rare soft tissue sarcomas occurring in the periarticular region originating from synovia. Synovial sarcomas occur less frequently in the neck, tongue, larynx, mediastinum, heart, lung, abdominal wall, small intestine, mesentery, and retroperitoneum. Primary pulmonary synovial sarcoma is a poor pathological condition without extrapulmonary involvement. In these rapidly progressing tumors, making quick decisions is important and performing complete resection is the best treatment that contributes to survival. Herein, we present a case of primary pulmonary synovial sarcoma in which we were able to achieve long-term survival with the multimodal approach after complete resection.