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Bronchopulmonary actinomycosis mimicking lung cancer
Actinomicosis broncopulmonar: simuladora de cáncer de pulmón
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Alrededor de la lesión se observan los típicos «gránulos de azufre» de color amarillento, muy característicos del género <span class="elsevierStyleItalic">Actinomyces</span>. B y C) Corresponden a la visión histopatológica por microscopia óptica: B) Se observa el tejido endobronquial teñido con hematoxilina-eosina y se señala con una flecha el «gránulo de azufre»; C) Se puede observar dicho gránulo a mayores aumentos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tomás José Posadas Blázquez, José Ramón Ferrando Gabarda, Andrés Briones Gómez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Tomás José" "apellidos" => "Posadas Blázquez" ] 1 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Ferrando Gabarda" ] 2 => array:2 [ "nombre" => "Andrés" "apellidos" => "Briones Gómez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212920301257" "doi" => "10.1016/j.arbr.2019.07.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301257?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619303096?idApp=UINPBA00003Z" "url" => "/03002896/0000005600000008/v2_202010270652/S0300289619303096/v2_202010270652/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1579212920301245" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.07.019" "estado" => "S300" "fechaPublicacion" => "2020-08-01" "aid" => "2225" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2020;56:523" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Late diagnosis of complex congenital pulmonary malformation: From symptoms and radiology to histopathology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "523" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Malformación pulmonar congénita compleja de diagnóstico tardío: de la clínica y radiología a la histopatología" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2054 "Ancho" => 1667 "Tamanyo" => 429210 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Anteroposterior chest X-ray shows right shift of the trachea and mediastinum, signs of air trapping, presence of a radiopaque image involving the left lower lobe, where multiple rounded radiolucent images (arrow), and left pleural effusion are seen. B) Chest CT shows solid-cystic lesion, without air bronchogram, with multiple cysts of variable size (arrow), from 5 to 15 mm, some converging to form larger cavities (asterisk). C and D) Gross examination found a specimen measuring 12 × 6 × 8 cm of friable tissue (arrow) with multiple cavities of varying size and purulent content (asterisk). E) Microscopy (H&E staining ×40) shows marked architectural alteration with multiple cystic formations (asterisks), the largest cystic formations (right, magnification ×100) being covered by a pseudostratified columnar epithelium (arrow) surrounded by thin fibromuscular walls and dense inflammatory infiltrate in the cystic and interstitial space, consistent with infected congenital cystic adenomatoid malformation type 2. F) Follow-up CT showing right and left upper lobe compensatory emphysema, and left posterior pleural and lateral thickening.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Susan Pumacayo-Cárdenas, Ernesto León-Bejarano, Arturo Recabarren-Lozada" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Susan" "apellidos" => "Pumacayo-Cárdenas" ] 1 => array:2 [ "nombre" => "Ernesto" "apellidos" => "León-Bejarano" ] 2 => array:2 [ "nombre" => "Arturo" "apellidos" => "Recabarren-Lozada" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289619303072" "doi" => "10.1016/j.arbres.2019.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619303072?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301245?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000008/v2_202008090657/S1579212920301245/v2_202008090657/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212920301580" "issn" => "15792129" "doi" => "10.1016/j.arbr.2020.03.014" "estado" => "S300" "fechaPublicacion" => "2020-08-01" "aid" => "2452" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Arch Bronconeumol. 2020;56:514-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Recommendations of SEPAR</span>" "titulo" => "Update of SEPAR Guideline “Diagnosis and Treatment of Drug-Resistant Tuberculosis”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "521" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización de la normativa SEPAR «Diagnóstico y tratamiento de la tuberculosis con resistencia a fármacos»" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1848 "Ancho" => 3167 "Tamanyo" => 541658 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristics of drugs with activity against <span class="elsevierStyleItalic">M. tuberculosis.</span> Adapted from Caminero et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">1</span></a> and Caminero et al.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">22</span></a> (<span class="elsevierStyleItalic">Updates Figure 2 of the 2017</span><span class="elsevierStyleItalic">guidelines</span><a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">1</span></a>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José A. Caminero, José-María García-García, Joan A. Caylà, Francisco J. García-Pérez, Juan J. Palacios, Juan Ruiz-Manzano" "autores" => array:6 [ 0 => array:2 [ "nombre" => "José A." "apellidos" => "Caminero" ] 1 => array:2 [ "nombre" => "José-María" "apellidos" => "García-García" ] 2 => array:2 [ "nombre" => "Joan A." "apellidos" => "Caylà" ] 3 => array:2 [ "nombre" => "Francisco J." "apellidos" => "García-Pérez" ] 4 => array:2 [ "nombre" => "Juan J." "apellidos" => "Palacios" ] 5 => array:2 [ "nombre" => "Juan" "apellidos" => "Ruiz-Manzano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289620301010" "doi" => "10.1016/j.arbres.2020.03.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289620301010?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301580?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000008/v2_202008090657/S1579212920301580/v2_202008090657/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Bronchopulmonary actinomycosis mimicking lung cancer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "522" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Tomás José Posadas Blázquez, José Ramón Ferrando Gabarda, Andrés Briones Gómez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Tomás José Posadas" "apellidos" => "Blázquez" "email" => array:1 [ 0 => "t.posadas21@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José Ramón Ferrando" "apellidos" => "Gabarda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Andrés Briones" "apellidos" => "Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitari i Politècnic La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario La Ribera, Alzira (Valencia), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actinomicosis broncopulmonar: simuladora de cáncer de pulmón" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 908 "Ancho" => 1667 "Tamanyo" => 185423 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Endoscopic image showing the occupation of the LMB by granulomatous tissue. Around the lesion are the typical yellowish sulfur granules, highly characteristic of the genus <span class="elsevierStyleItalic">Actinomyces</span>. (B and C) Histopathological view by optical microscopy: (B) endobronchial tissue stained with hematoxylin-eosin and sulfur granule indicated by an arrow; (C) this granule can be observed at higher magnifications.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 65-year-old immunocompetent man with no clinical history of interest and no toxic habits or chronic drug use, who consulted with a 6-month history of productive chronic cough. He had no fever or hemoptysis, and no chest pain or dyspnea on exertion. He had no loss of appetite and no other symptoms and his weight was stable.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination showed no findings of interest. Although no changes were observed on chest X-ray, a chest computed tomography (CT) scan was performed. This showed thickening of the distal wall of the left main bronchus (LMB) which had acquired a nodular morphology causing complete stenosis. We performed a whole body positron emission tomography (PET)/CT scan which revealed hypermetabolism in the described lesion with absence of signs of metabolic involvement or activity in any other location.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Granulomatous tissue resembling a cancerous lesion completely occluding the LMB was visualized on flexible fiberoptic bronchoscopy. Endoscopic biopsy was performed by cryoprobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) with both diagnostic and therapeutic intent with decompression. Histopathology revealed the absence of malignant cellularity and numerous actinomyces colonies.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Actinomycosis is a rare, slowly progressive, and difficult-to-diagnose infection. The genus <span class="elsevierStyleItalic">Actinomyces</span> is a commensal of the oropharynx, respiratory tract and digestive tract. Clinical manifestations are non-specific, but may be confused with lung tumors<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> and may lead to misdiagnosis and therefore incorrect therapy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-16" "fechaAceptado" => "2019-07-12" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Posadas Blázquez TJ, Ferrando Gabarda JR, Briones Gómez A. Actinomicosis broncopulmonar: simuladora de cáncer de pulmón. Arch Bronconeumol. 2020;56:522.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 908 "Ancho" => 1667 "Tamanyo" => 185423 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Endoscopic image showing the occupation of the LMB by granulomatous tissue. Around the lesion are the typical yellowish sulfur granules, highly characteristic of the genus <span class="elsevierStyleItalic">Actinomyces</span>. (B and C) Histopathological view by optical microscopy: (B) endobronchial tissue stained with hematoxylin-eosin and sulfur granule indicated by an arrow; (C) this granule can be observed at higher magnifications.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary bronchopulmonary actinomycosis masquerading as lung cancer: apropos of two cases and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Katsenos" 1 => "I. Galinos" 2 => "P. Styliara" 3 => "N. Galanopoulou" 4 => "K. Psathakis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Case Rep Infect Dis" "fecha" => "2015" "volumen" => "2015" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary actinomycosis: a great clinical polymorphism [Article in French]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Fekih" 1 => "H. Abdelghaffar" 2 => "D. Belhabib" 3 => "L. Boussoffara" 4 => "I. Akrout" 5 => "A. Marghli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Tunis Med" "fecha" => "2011" "volumen" => "89" "paginaInicial" => "386" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21484692" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack476657" "titulo" => "Acknowledgements" "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">We would like to thank the Anatomical Pathology Service of the University Hospital La Ribera de Alzira, Valencia, with special mention to Dr. Laia Bernet Vegué for her collaboration and invaluable assistance in confirming the diagnosis of the case presented.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005600000008/v2_202008090657/S1579212920301257/v2_202008090657/en/main.assets" "Apartado" => array:4 [ "identificador" => "60604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005600000008/v2_202008090657/S1579212920301257/v2_202008090657/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301257?idApp=UINPBA00003Z" ]
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