Richard Kradin

Mass General Hospital · medicine and pathology

Aims NUT carcinoma, a rare aggressive tumor driven by NUTM1 rearrangements, often involves the lung/mediastinum and shows squamous differentiation. We encountered an index patient with a thoracic NUT carcinoma diagnosed by molecular testing, demonstrating extensive pleural involvement and diffuse TTF‐1 expressions initially suggestive of lung adeno...

Background: Asbestos is the primary known cause of malignant mesothelioma. Some cosmetic talc products have been shown to contain asbestos. Recently, repeated exposures to cosmetic talc have been implicated as a cause of mesothelioma. Methods: Seventy-five individuals (64 females; 11 males) with malignant mesothelioma, whose only known exposure...

Calcifying fibrous pseudotumor (CFP) is a rare, benign soft tissue tumor that may uncommonly arise in the pleura. These tumors can show multifocal dissemination across the pleural surface, but the mechanism underlying this dissemination is unclear. Review of previously reported cases of pleural CFP demonstrates a strong predilection for basal and d...

Malignant mesothelioma is a rare and aggressive cancer most typically associated with prior asbestos exposure. The nature of the relationship between asbestos exposure and hereditary familial syndromes predisposing to malignancy has not been determined. We report two Lynch syndrome patients with paraoccupational asbestos exposure who developed diff...

Improved tools have led to a burgeoning understanding of lung regeneration in mice, but it is not yet known how these insights may be relevant to acute lung injury in humans. We report in detail two cases of fulminant idiopathic acute lung injury requiring extracorporeal membrane oxygenation in previously healthy young adults with acute respiratory...

Perivascular epithelioid cell tumor (PEComa), mesenchymal tumors morphologically characterized by epithelioid cells, coexpress melanocytic and muscle markers. Herein, we describe a heretofore-undescribed tuberous sclerosis complex (TSC)-related neoplasm, morphologically resembling a soft tissue fibroma-like lesion, but showing an immunophenotype re...

Background: Diffuse peritoneal malignant mesothelioma (DPM) is caused by exposure to asbestos. The medical literature has linked DPM primarily to high levels of asbestos exposure, in particular amosite. Controversy persists as to whether chrysotile is capable of causing DPM, especially when exposures are paraoccupational. Methods: Sixty-two subj...

Background: Cigarette smoke and asbestos are recognized causes of lung carcinoma and together promote carcinogenesis. Adenocarcinoma is currently the most common cause of lung cancer in the USA and it has been linked to both smoking and asbestos exposure. Mutations in the epidermal growth factor gene receptor (EGFR) occur predominantly in non-smok...

An interstitial lung disease is one of the most challenging areas of pulmonary medicine both for pulmonologists and pulmonary pathologists. The topic continues to be revisited with novel classifications. It is incumbent that pulmonologists be aware of the pitfalls in establishing diagnoses in this area.

A large number of toxic environmental agents can produce a spectrum of lung injuries. Some of these can cause both benign and malignant diseases. Pulmonologists need to be acquainted with the spectrum of occupational lung diseases and how to diagnose them.

There are a number of pulmonary disorders that are not readily classified and these are discussed here. Some produce serious diseases, whereas others are largely pathological curiosities that may be unknown to clinicians.

The structure of the lung determines its function. The various compartments of the lung are specially adapted to serve the activities of the lung. Pulmonary pathology is defined by the changes that occur in the underlying anatomy of the lung.

Pulmonary pediatric disease is an area that many adult pulmonologists are not well exposed to. There have been recent advances in the classification of these disorders and many patients with pediatric disease are surviving into adulthood.

The reaction patterns of each of the compartments of the lung are largely stereotypic. To assess pulmonary pathology, one should become conversant with the temporal sequences of pulmonary inflammation.

Lung cancer is the most lethal form of malignancy. Most cases of lung cancer are attributed to cigarette smoking but many causes of lung cancer have been identified. Recently, there have been major breakthroughs in understanding the molecular mechanisms of lung cancer and the ability to identify mutations that can be therapeutically targeted.

The diseases of the pulmonary airways are the most common disorders encountered in the practice of pulmonology. Although most are not biosied, the pathology of these disorders is critical to understand how best to approach them therapeutically.

A 22-year-old man was admitted to the intensive care unit in the winter because of hypoxemia and shock. A chest radiograph was notable for diffuse bilateral consolidations. A rapid influenza test was negative. Diagnostic test results were received.

The recent introduction of new US Food and Drug Administration-approved medications for the treatment of idiopathic pulmonary fibrosis/usual interstitial pneumonia raises important concerns about the accuracy of diagnosis. The term honeycomb lung, used widely by radiologists and pathologists in the diagnosis of usual interstitial pneumonia, represe...

A 57-year-old man was admitted to the intensive care unit in the winter because of severe pneumonia and acute hypoxemic respiratory failure. One month earlier, he had returned from a trip to Southeast Asia. Diagnostic procedures were performed.

Pulmonary capillary hemangiomatosis (PCH) is a rare form of pulmonary arterial hypertension (PAH) characterized by pulmonary capillary proliferation and pseudoinvasion of collagenous septal structures. PCH is often accompanied by veno-occlusive changes and pulmonary hypertensive arterial remodeling. The clinical and pathological diagnosis of PCH ca...

The diagnosis of pulmonary asbestosis is most often established based on clinical criteria and has both clinical and legal implications. Unfortunately, one of the confounding features in the diagnosis may be a history of cigarette abuse, which can produce interstitial opacities on chest imaging as well as diffusion defects on pulmonary function tes...

Humoral immune deficiencies have been associated with noninfectious disease complications including autoimmune cytopenias and pulmonary disease. Herein we present a patient who underwent splenectomy for autoimmune cytopenias and subsequently was diagnosed with humoral immune deficiency in the context of recurrent infections. Immunoglobulin analysis...

In his analyses of obsessional patients, Sigmund Freud suggested that they suffered from intrusive cognitions and compulsive activities. Early psychoanalysts delineated the phenomenology of obsessionality, but did not differentiate what is currently termed obsessive-compulsive disorder from obsessional personality. However, it was widely recognized...

A 64-year-old man was admitted to the hospital with recurrent pleuritic chest pain. Imaging showed a loculated left pleural effusion and underlying consolidation in the left lower lobe. Treatment with antibiotics brought some improvement, but pain recurred and worsened.

Cigarette smoking is an established cause of lung cancer. However, pulmonary fibrosis is also an independent risk factor for the development of lung cancer. Smoking-related interstitial fibrosis (SRIF) has recently been reported. We hypothesized that adenocarcinomas in lungs with SRIF might show distinct molecular changes and examined the molecular...

A 45-year-old man was admitted to the hospital because of diffuse, purple, blanching livedo and signs of severe sepsis. Three days earlier, he had been bitten by a dog. A diagnostic test result was received.

The fourth edition of this authoritative text covers every aspect of liver disease affecting infants, children and adolescents. As in the previous editions, it offers an integrative approach to the science and clinical practice of pediatric hepatology and charts the substantial progress in understanding and treating these diseases. All of the chapt...

Name of Virus: Influenza virus

A 29-year-old man was seen in an outpatient clinic because of abdominal pain, fever, and weight loss. Testing for HIV antibodies was positive, and the CD4 T-lymphocyte count was 10 per cubic millimeter. Chest imaging revealed tiny nodules in both lungs.

Organizing pneumonia (OP) is a histopathologic pattern of response to lung injury. Fibrin is a marker of acute microvascular injury, and variable amounts of intraalveolar fibrin are seen in OP; however, its relevance to clinical outcomes is unclear. We examined lung wedge biopsies of 26 patients with cryptogenic organizing pneumonia (COP), assessed...

Acute lung injury occurs in a third of patients with smoke inhalation injury. Its clinical manifestations usually do not appear until 48-72 h after inhalation. Identifying inflammatory changes that occur in pulmonary parenchyma earlier than that could provide insight into the pathogenesis of smoke-induced acute lung injury. Furthermore, noninvasive...

Name: Herpesvirus-4. © 2014 Springer-Verlag Berlin Heidelberg. All rights are reserved.

Name of Virus: Varicella Zoster Virus. © 2014 Springer-Verlag Berlin Heidelberg. All rights are reserved.

Viruses that primarily target the lung are very significant causes of death and in the past decade have been responsible for major outbreaks of severe adult respiratory distress syndrome and H1N1 influenza. This book is distinctive in that the entire spectrum of viral disease of the lung is conveniently compiled within a single volume. The epidemio...

From the Departments of Medicine (J.C.F.), Radiology (J.-A.O.S.), and Pathology (R.L.K.), Massachusetts General Hospital, and the Departments of Medicine (J.C.F.), Radiology (J.-A.O.S.), and Pathology (R.L.K.), Harvard Medical School — both in Boston.

Purpose: We investigated the metabolic response of lung cancer to radiotherapy or chemoradiotherapy by (18)F-FDG PET and its utility in guiding timely supplementary therapy. Methods: Glucose metabolic rate (MRglc) was measured in primary lung cancers during the 3 weeks before, and 10-12 days (S2), 3 months (S3), 6 months (S4), and 12 months (S5)...

Radiofrequency ablation of pulmonary veins is a common therapeutic intervention for atrial fibrillation. Pulmonary vein stenosis and venoocclusive disease are recognized complications, but the spectrum of pathologies postablation have not been previously reviewed. A recent case at our hospital showed a left hilar soft tissue mass in association wit...

Increasing subspecialization in the practice of medicine has led to certain discrepancies in how pathologists and pulmonologists imagine lung disease. This article, written by a pathologist who also practices pulmonology at a large, academic hospital, highlights his perspective on the important role of the pathologist in guiding the hand of the pul...

The ancestral claims on an individual can evoke mental conflict when they involve separating from an ethnic group whose beliefs and customs are devalued by the dominant culture. However, these claims are engraved on the psyche early in development by caretakers to the level of pre-object relatedness, where contents and affect tones are implicit and...

Silicone, commonly used in cosmetic procedures owing to its presumed inertness, can yield serious sequelae including acute embolization and pneumonitis. Chronic pulmonary sequelae in response to silicone injection have not been previously described. We report a case of chronic progressive granulomatous pneumonitis in response to subcutaneous silico...

Necrotizing fasciitis due to Pseudomonas aeruginosa is rare. We report a case of monomicrobial Pseudomonas necrotizing fasciitis and review 37 cases in the literature. The mortality rate was 30%, and most infections occurred in the immunocompromised. Clinicians should consider empiric pseudomonal antibiotic coverage in the severely immunocompromise...

Recent studies demonstrate that long palate, lung, and nasal epithelium clone 1 protein (LPLUNC1) is involved in immune responses to Vibrio cholerae, and that variations in the LPLUNC1 promoter influence susceptibility to severe cholera in humans. However, no functional role for LPLUNC1 has been identified. We investigated the role of LPLUNC1 in im...

Pulmonary alveolar proteinosis (PAP) is a rare condition in which pulmonary macrophages fail to clear surfactant, resulting in the alveolar accumulation of lipoproteinaceous debris. The histopathology of PAP is typified by diffuse filling of terminal airways with eosinophilic, PAS/diastase (PAS/D)-positive acellular material. We present five patien...

The placebo response represents an enigmatic element of therapeutics. The potency of placebo effects is highlighted by the fact that the current gold standard for determining therapeutic efficacy, the randomized controlled clinical trial, is based on identifying treatment responses that are statistically superior to those elicited by a placebo. Alt...

Placebo responses are automatic and unconscious and cannot be predicted based on conscious volition. Instead, they reflect complex interactions between the innate reward system of the nervous system and encoded procedural memories and imaginal fantasies. The placebo response contributes inextricably to virtually all therapeutic effects, varies in p...

Malacoplakia is a benign and uncommon inflammatory response that develops most frequently in the genitourinary tract but has been reported at other sites. We report the case of 67-year-old man who presented with a lesion at the base of the tongue 7 months after chemoradiation for biopsy-proven invasive squamous cell carcinoma of the tongue. The les...

Psychosomatic disorders represent a therapeutic conundrum. Despite compelling evidence to suggest the integrity of mind and body, humans are famously prone to experiencing them as separate. This paper explores the scientific challenges posed by psychosomatic disorders and how changing cultural notions contribute to their perplexing presentations. E...

To identify CT findings that predict mortality in acute respiratory distress syndrome (ARDS) and to identify CT findings that differentiate diffuse alveolar damage (DAD) from DAD with prominent histopathological features of organizing pneumonia (DAD-OP). Twenty-eight patients with ARDS (corroborated by open biopsy) and chest CT within 2 weeks of bi...

Placebo effects are a potentially inherent element in all treatment responses, and as such, they play a critical role in determining what is "therapeutic." However, the placebo response is also an area of substantial controversy. In the present review, the scientific issues that influence placebo effects are elucidated. The evolution of the concept...

Aspergillus spp. are responsible for a broad spectrum of human disorders ranging from benign colonisation of mucosal surfaces to life-threatening angioinvasive infection. Diagnosing the array of disorders caused by Aspergillus spp. can be challenging. In the case of the hypersensitivity responses to Aspergillus species, i.e., allergic bronchopulmon...

Comprehensive and up to date, the Second Edition of Diagnostic Pathology: Infectious Disease, by Dr. Richard Kradin, is an invaluable tool for the accurate diagnosis of any infectious disease?from the common to the most challenging. The organ-based format makes it an especially useful tool for surgical pathologists' daily diagnostic and management...

Context.—Whole-slide imaging technology offers promise for rapid, Internet-based telepathology consultations between institutions. Before implementation, technical issues, pathologist adaptability, and morphologic pitfalls must be well characterized. Objective.—To determine whether interpretation of whole-slide images differed from glass-slide inte...

-Whole-slide imaging technology offers promise for rapid, Internet-based telepathology consultations between institutions. Before implementation, technical issues, pathologist adaptability, and morphologic pitfalls must be well characterized. -To determine whether interpretation of whole-slide images differed from glass-slide interpretation in diff...

Patients with preleukemic myeloid neoplasia can develop nonhematologic disease. Five patients with the myelodysplastic syndrome presented with interstitial lung disease that heralded acute leukemia in 3. Chest radiographs showed diffuse interstitial opacities, and the lung biopsies showed diffuse cellular interstitial and fibrosing pneumonitis with...

Current concepts of the pathophysiology of necrotizing fasciitis (NF), a life-threatening infection of soft tissues associated with a toxic shock syndrome, emphasizes the role of bacterial superantigens as mediators of cytokine release by immune lymphocytes. In order to assess the cellular basis of immune activation, immunohistochemistry was applie...

A 25-year-old man was admitted to this hospital because of coma after cardiac arrest. Cardiopulmonary resuscitation was performed, and a junctional rhythm was established. On admission, the patient remained unconscious. Despite aggressive measures, the patient met criteria for brain death, and his family agreed to organ donation. During the procure...

According to Carl Jung the mythopoeic activities of the collective unconscious contribute to the trajectory of personal individuation ( Segal 1998 ). The ‘family myth’ represents an imaginal narrative that emphasizes the importance of the family's founders, its collective values, and its position with respect to ‘outsiders’. Sigmund Freud identifie...

Pulmonary vein stenosis is a known, yet under-recognized complication of radiofrequency ablation for atrial fibrillation. We present the case of a patient developing complete left-sided pulmonary venous occlusion following radiofrequency ablation. Recommendations are made to allow earlier diagnosis of this complication.

A 25-year-old man was transferred to the emergency department of this hospital because of pain and swelling of the right hand and hypotension. His hand was mottled and swollen, with a black eschar on the dorsum, and soft-tissue swelling extended up the proximal forearm. Vigorous fluid resuscitation and norepinephrine were required for hemodynamic s...

The antiarrhythmic drug amiodarone accumulates in many organs of the body. Amiodarone lung disease (ALD) most commonly manifests clinically as an interstitial pneumonitis. The few reports of nodular ALD generally have been in the clinical and radiographic literature. No detailed histopathologic analysis of nodular ALD is available. We report 4 pati...

From the Departments of Pediatrics– Pediatric Infectious Disease (J.B.H., I.C.M.), Radiology (S.J.W.), and Pathology (R.L.K.), Massachusetts General Hospital; and the Departments of Pediatrics (J.B.H., I.C.M.), Radiology (S.J.W.), and Pathology (R.L.K.), Harvard Medical School.