Clinical appearance, radiologic findings, lung function and results of corticosteroid therapy were analyzed in 42 adult cases of biopsy-proven pulmonary histiocytosis X. Symptoms were present in only 64%. Using the ILO classification 1980, the evaluation of chest radiographs revealed all categories of profusion, size and shape of nodules. The characteristic ‘ring figures’, i.e. thin-walled cysts, in the parenchyma were detected in 78% of conventional tomographies (n = 27) and in all patients examined by CT (n = 5). In patients with early disease, lung function tests (n = 26) including body plethysmography, pulmonary diffusing capacity and ergospirometry revealed that parameters of gas exchange are most sensitive (T_{L, co} 84%, K_co 72%). Bronchial reactivity to carbachol was significantly higher than in controls (n = 12). Lung perfusion scintigram showed an abnormal, but uncharacteristic pattern in 81% (n = 26). During corticosteroid therapy, no progression was observed (n = 36). 85% of patients with radiographic evidence of progressive disease improved after administration of corticosteroids (n = 14).

Sarcoidosis is a chronic, systemic, noncaseating granulomatous disease process of unknown etiology. Sarcoidosis most commonly manifests in the lungs; however, gastrointestinal manifestations can occur. If in the GI tract, it is almost always found in the liver. Solitary pancreatic lesions are extremely rare, with less than 50 documented cases found in the literature. We present a case of a 61-year-old female, with a past medical history of sarcoidosis, who presented to the ER with unexpected weight loss, scleral icterus, right upper quadrant pain, and epigastric and back pain. US and MRI found a dilated common bile duct and mild dilation of the pancreatic duct, as well as a focal prominence in the head of the pancreas surrounded by areas of atrophy. A pancreaticoduodenectomy procedure was performed and fresh frozen sections were taken. The pathologist made a diagnosis of nonnecrotizing granulomatous pancreatitis. Pancreatic sarcoid is often asymptomatic and a benign finding on autopsy; however, clinicians should be mindful of pancreatic involvement when working up differential diagnosis for pancreatic masses.

Sarcomatoid carcinoma is a rare histologic subtype of non-small cell lung cancer (NSCLC) that contains a component of sarcoma or sarcoma like elements(1) comprises less than 1 % of all lung cancers. CASE PRESENTATION: A 62-year-old woman with history of smoking presented to the emergency room for complaints of sharp sternal chest pain. On further inquiry, she complained of progressive dyspnea with a decline in her exercise tolerance. She also had a significant weightloss of 20-pound in the last 6 months. On examination, she was normotensive, afebrile. On auscultation, there were decreased breath sounds in the left upper lung with an increased expiratory phase.? CT of the chest revealed partial consolidation of the left upper lobe extending to the hilum with adjacent hilar and left mediastinal adenopathy. It also demonstrated several small nodular opacities within the right upper and middle lobes. A bronchoscopy was performed with brushing, endobronchial biopsy, and alveolar lavage of left upper lobe. Pathology showed poorly differentiated non-small cell carcinoma with giant cells and focal spindle cell features. DISCUSSION: Classification of these sarcomatoid carcinomas has been controversial due to variations in phenotype. As per the WHO classification of lung tumors, sarcomatoid carcinomas include pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma. (2)It usually presents as cough and hemoptysis in middle-aged men with history of smoking. The tumors are usually large, solitary upper lobes lesions. CONCLUSIONS: Sarcomatoid carcinomas can be difficult to identify and diagnose. There are no distinguishing radiologic features specific to these tumors and diagnosis cannot be made on the basis of cytology or small biopsy, however, features suggestive of the tumor in a small sampling may be mentioned on a descriptive basis, that is, poorly differentiated NSCLC with spindle and or giant cell carcinoma [2].