#hemogram

[vetmundoo]

Köpeklerin hemogram testleri, bir veterinerin köpeğin sağlık durumunu değerlendirmesine yardımcı olabilir ve olası bir enfeksiyon, anemi, kanama veya diğer sağlık sorunlarının belirlenmesine yardımcı olabilir. Hemogram, bir hayvanın kanında bulunan hücrelerin sayısını ve tipini ölçen bir testtir.

Köpeklerin hemogram testlerindeki normal parametreler, köpeğin yaşına, cinsiyetine ve ırkına göre değişebilir. Ayrıca, laboratuvarlarda kullanılan test yöntemleri de sonuçları etkileyebilir. Bu nedenle, veteriner hekiminiz köpeğinizin test sonuçlarını yorumlamalı ve size normal aralıkları söylemelidir.

Yazımızın devamını web sitemizden okuyabilirsiniz.

[thinkingimages]

Joan Fontcuberta | Hemograms

[fatihmedikal]

Hemogram Kan Alma Tüpü (Mor Kapak): Kan Testlerinde Güvenilir Çözümler

Laboratuvar testlerinde kullanılan tıbbi malzemeler, doğru sonuçlar elde edilmesi açısından hayati önem taşır. Hemogram kan alma tüpü (mor kapak), tam kan sayımı (CBC) ve diğer hematolojik testlerde kullanılan temel bir laboratuvar malzemesidir. Mor kapaklı bu tüpler, kanın pıhtılaşmasını engellemek ve hücrelerin bozulmadan laboratuvara ulaşmasını sağlamak amacıyla geliştirilmiştir. Özellikle hematolojik analizlerde güvenilir sonuçlar almak için mor kapaklı hemogram tüpleri kullanılır.

Hemogram Kan Alma Tüpü (Mor Kapak) Nedir?

Hemogram kan alma tüpü, kanın laboratuvarda incelenmek üzere toplanmasını sağlayan steril bir tüptür. Mor kapaklı tüplerin içinde bulunan EDTA (Etilendiamintetraasetik Asit) maddesi, kanın pıhtılaşmasını engeller ve kan hücrelerinin bütünlüğünü korur. Bu tüpler, özellikle tam kan sayımı (CBC), alyuvar, akyuvar ve trombosit sayımı gibi temel hematolojik testlerde kullanılır.

Mor kapaklı tüpler, tam kan sayımı testleri sırasında hücrelerin şekillerini ve sayımlarını koruyarak doğru sonuçlar elde edilmesine yardımcı olur. Kanın pıhtılaşmasını engelleyen bu tüpler, laboratuvar ortamında yapılan testlerde sıkça tercih edilir.

Hemogram Kan Alma Tüpü Teknik Özellikleri

Mor kapaklı hemogram kan alma tüpleri, spesifik kan testleri için özel olarak üretilmiştir. Tüplerin özellikleri şu şekildedir:

• Kapak Rengi: Mor

• İçerik: EDTA (Etilendiamintetraasetik Asit) antikoagülan

• Kullanım Alanı: Tam kan sayımı (CBC), hematolojik testler

• Kapasite: Genellikle 2 ml — 5 ml arasında kan alma kapasitesi

• Malzeme: Plastik veya cam, sterilize edilmiş

• Sterilizasyon: Tamamen steril, tek kullanımlık

Hemogram Kan Alma Tüpü Ne İşe Yarar?

Mor kapaklı hemogram kan alma tüpleri, kanın pıhtılaşmasını önleyerek kan hücrelerinin analiz edilmesine olanak tanır. Bu tüpler, tam kan sayımı ve diğer kan hücrelerine yönelik testlerde kullanılır. EDTA maddesi sayesinde kan hücreleri bozulmadan korunur ve laboratuvar testlerinde doğru sonuçlar elde edilir.

Bu tüplerin içinde bulunan antikoagülan maddesi, kanın laboratuvara taşınması sırasında pıhtılaşmasını engeller ve hücrelerin doğal yapısını korur. Özellikle hematolojik testlerin doğruluğu, bu tüplerin işlevselliğine bağlıdır. Bu nedenle, laboratuvarlar ve tıbbi test merkezleri tarafından yaygın olarak tercih edilir.

Hemogram Kan Alma Tüpü Nereden Satın Alınır?

Laboratuvar testlerinde kullanılan tüm malzemelerin kalite ve güvenilirliği büyük önem taşır. Mor kapaklı hemogram kan alma tüpleri, güvenilir medikal tedarikçilerden temin edilmelidir. Fatih Medikal Sağlık Sistemleri, yüksek kaliteli hemogram tüplerini sizlere sunarak laboratuvar testlerinizin doğruluğunu ve güvenilirliğini sağlar.

Hemogram kan alma tüpü (mor kapak) ve diğer laboratuvar malzemeleri konusunda ihtiyaç duyduğunuz her türlü bilgiyi firmamızdan alabilirsiniz.

Hemogram Kan Alma Tüpü Fiyatları

Mor kapaklı hemogram kan alma tüpleri fiyatları, ürünün kapasitesine, malzeme kalitesine ve sterilizasyon özelliklerine göre değişiklik gösterebilir. Fatih Medikal Sağlık Sistemleri, rekabetçi fiyatlarla en yüksek kalite standartlarına sahip hemogram tüplerini sunmaktadır. Fiyatlar ve detaylı bilgi almak için bizimle iletişime geçebilir ve size en uygun çözümleri bulabilirsiniz.

Sonuç

Laboratuvar testlerinin doğruluğu için kullanılan mor kapaklı hemogram kan alma tüpleri, kanın pıhtılaşmasını engelleyerek güvenilir sonuçlar elde edilmesine olanak tanır. Fatih Medikal Sağlık Sistemleri, hemogram tüpleri ve diğer tıbbi malzemeler konusunda sizlere en kaliteli ürünleri sunarak, laboratuvar çalışmalarınızı güvence altına alır.

[tauforged]

oh shit i got my fucking hemogram results back!

[magnecalliope]

#500?????? WHAT#private clinics will charge 25 at most for a hemogram here in my country????#HOW IS THAT WORTH 500#I CANT EVEN THINK OF A SINGLE BLOOD EXAM THAT COSTS THAT MUCH#WHAT THE FUCK

That's exactly why the insurance company is only billed $25 here, @error-523scintilla. The $475 extra that I was charged is a mark up. This segment from Adam Ruins Everything is a good explanation for how it works:

I’ve got my tumblr inbox turned off so I really have to commend the person who actually emailed me to let me know they don’t like the things I’ve posted about the UnitedHealth CEO being murdered on their commitment to their beliefs.

But seen as how you emailed me from a dud email that appears to be bouncing back replies and I really wanted to address something you said to me about violence begetting violence:

My migraine medication, the medication I was given for my debilitating neurological disease that has gotten so bad I spent most of this year actively suicidal, costs $1300 a month.

My insurance covered it. But only because my doctors office went to fucking war for me because I’m a high anaphylaxis risk for the drugs the insurance wanted me to try.

Because that’s the thing.

My doctors knew, based on my documented medical history, I likely wouldn’t be a good fit for the “first line” of preventative migraine drugs, but because of insurance, I had to be given drugs that were contradictory to my other life threatening conditions, because otherwise insurance wouldn’t cover anything else.

I failed them. Spectacularly and with an anaphylactic reaction to one of them. And I was still warned insurance would fight me because I hadn’t tried the remaining drug they wanted me to try.

A drug which I would have to take in an ER waiting room because my mast cell disease is unpredictable but insurance wouldn’t cover in-patient treatment to let me try it safely under medical supervision.

Is that not violence?

Were all the times I was denied coverage for vital and necessary procedures that could have prevented my disabilities from worsening not violence?

Maybe not in the sense you mean. But I assure you it felt very much like violence to me.

Do I condone murder? No, obviously. But I’m also sick and tired of people pretending that what is happening to the American people every day isn’t eugenics through class warfare.

Violence begets violence.

It sure fucking does.

Maybe these insurance companies should have thought of that first.

[vetmundoo]

Kedilerin hemogram sonuçları, veteriner hekim tarafından değerlendirilmesi gereken önemli bir tıbbi testtir. Hemogram, kedilerin kan parametrelerinin ölçülmesine ve belirlenmesine yardımcı olan bir testtir. Bu test, kedinin sağlık durumu hakkında değerli bilgiler sağlayabilir ve birçok farklı hastalığın tanısına yardımcı olabilir. Ancak, hemogram sonuçları tek başına yorumlanmamalıdır.

Yazımızın devamını web sitemizden okuyabilirsiniz.

https://vetmundo.com.tr/kedilerin-hemogram-sonuclari/

[yourhealthrescue]

Understanding Complex Nature and Treatment Options For Kidney Cancer

When seeking the Best Hospital for Kidney Surgery in India, it is essential to understand kidney cancer and its complexities. Though this type of cancer grows slowly in most cases, it can exhibit aggressive behavior in certain patients, demanding advanced and timely care. Kidney cancer accounts for approximately three percent of all cancers, with renal cell carcinoma being the most prevalent subtype. While more common in the USA, its incidence in India is on the rise.

Causes of Kidney Cancer The exact cause of kidney cancer remains unclear, but several environmental and genetic factors are associated with its development:

Environmental risks such as smoking, exposure to cadmium, and asbestos

Genetic predisposition and hereditary links

More common in males aged 60 to 70

Sedentary lifestyle and obesity as contributing factors

Symptoms of Kidney Cancer The symptoms of kidney cancer often relate to the primary tumor, though they may vary based on the stage of the disease:

Primary symptoms: Hematuria (blood in urine), flank pain, and abdominal mass

Systemic symptoms: Unexplained weight loss, fever, and high calcium levels in the blood (hypercalcemia)

Advanced disease symptoms: Bone pain, backaches from bone metastasis, lung-related breathing difficulties, and rare occurrences like headaches, vomiting, and brain metastasis

Anemia and persistent fatigue can also be indicative of kidney cancer in some cases.

Diagnosis of Kidney Cancer Diagnosing kidney cancer involves a comprehensive approach:

Detailed physical examination

Blood tests, including hemogram and blood chemistry

Imaging techniques like ultrasound, CT scans, and MRI

Confirmatory histological diagnosis through FNAC or Trucut biopsy

At the Best Hospital for Kidney Surgery in India, specialists use advanced diagnostic tools to ensure accurate evaluation and tailored treatment plans.

Management and Treatment Options The treatment of renal cell carcinoma (RCC) has evolved significantly, particularly for advanced or recurrent cases.

Early-Stage Treatment Radical surgery remains the gold standard for localized kidney tumors, offering a curative approach for most patients.

Advanced Stage Treatment While kidney cancer is generally resistant to radiation and chemotherapy, biologic therapies such as Interferon and Interleukin-2 have been used with limited success.

Latest Advances in Kidney Cancer Treatment Recent advancements in molecular oncology have revolutionized kidney cancer treatment:

Targeted Therapies: Dual kinase inhibitors like Sutent and Nexavar have demonstrated promising outcomes.

VEGF Inhibitors: Drugs like Bevacizumab (Avastin) offer improved survival rates.

m-TOR Inhibitors: Novel agents that provide effective treatment options when previous therapies fail.

These advanced treatments have significantly extended survival rates and improved the quality of life for patients.

Why Choose India for Kidney Cancer Treatment? India has emerged as a global destination for high-quality healthcare services. Leading hospitals and specialists offer state-of-the-art treatment options, personalized care, and comprehensive support for international patients.

At the Best Cancer Hospitals in India, patients receive cutting-edge care, including advanced diagnostic tools, world-class surgical procedures, and compassionate follow-up care. We assist patients with:

Medical visa assistance

Appointment scheduling with certified specialists

All-inclusive treatment packages covering consultation fees, investigations, nursing care, and medication

Accommodation arrangements, airport transfers, and interpreter services when needed

Choose Medaviate for Expert Guidance Medaviate has helped countless patients regain their health and lead a fulfilling life. We specialize in guiding you to the Best Hospital for Kidney Surgery in India or the Best Cancer Hospitals in India based on your specific requirements and budget.

With our end-to-end services, we ensure a seamless treatment journey, offering not just hope but a concrete path toward recovery.

[manisadasunnet]

Hematoloji: Kan Hastalıkları Hematoloji, kan ve kan hücreleri ile ilgili hastalıkların teşhis ve tedavisine odaklanan hayati bir tıp dalıdır. Kırmızı kan hücreleri (eritrositler), beyaz kan hücreleri (lökositler), kan pulcukları (trombositler) ve kanın pıhtılaşma mekanizmaları gibi konuları kapsar. Bu disiplinde, kansızlık (anemi), lösemi, lenfoma, hemofili ve trombosit bozuklukları gibi hastalıklar üzerine yoğun araştırma ve tedavi uygulamaları yürütülür. Kan testi sonuçlarındaki anormal değerlerin nedenleri ve bu sonuçların nasıl yorumlanacağı, hematoloji alanının temel araştırma konularındandır. Tam kan sayımı (hemogram), biyokimya testleri, kemik iliği incelemesi ve çeşitli pıhtılaşma testleri, bu hastalıkların erken teşhisinde yol gösterici olur. Erken teşhis sayesinde, birçok kan hastalığının tedavi süreci daha başarılı ve hızlı ilerler. Hematolojik hastalıkların tedavisi, genellikle ilaç tedavileri (örn. kemoterapi, immünoterapi) veya kan nakli gibi yöntemleri içerir. Bazı durumlarda kemik iliği (kök hücre) nakli, hastalar için kalıcı çözüm sağlayabilir. Bu süreçte, düzenli hekim kontrolü ve laboratuvar takibi son derece önemlidir. Ayrıca, beslenme, egzersiz ve yaşam tarzı değişiklikleri de hastaların genel sağlık durumunu korumada önemli rol oynar. https://www.aligurtuna.com/hematoloji/ #manisadaçocukcerrahı #manisadacocukcerrahisiuzmani #manisadadoktor #manisadaçocukdoktoru #manisadacerrah #opdraligurtuna @opdraligurtuna @op.dr.aligurtuna Read the full article

[pazaryerigundem]

Ankara'da can dostlar sıcak yuvalarına kavuştu

https://pazaryerigundem.com/haber/197499/ankarada-can-dostlar-sicak-yuvalarina-kavustu/

Ankara'da can dostlar sıcak yuvalarına kavuştu

Ankara Keçiören Belediyesi Pati Yaşam Köyü’nde 3 can dost daha sıcak yuvasına kavuştu.

ANKARA (İGFA) – Barınakta misafir edilen köpekleri sahiplenen Şilan Özkan (23), Berzan Özkan (23) ve Uğur Özkan (28) isimli hayvanseverlerin mutlulukları gözlerine yansırken, tüm can dostların sıcak bir yuvaya ihtiyacı olduğunu vurgulayarak, satın alma sahiplen mesajı verdiler. Sokak hayvanlarını misafir ettiği için ve yuva bulmalarına aracı olduğu için Keçiören Belediyesine teşekkür eden hayvanseverler, imkânı olan herkesin sokak hayvanlarını sahiplenmesi tavsiyesinde bulundular.

Barınakta can dostlar bakım ve gözetim altında

Sokak hayvanlarını sahiplendirmek için çalışmalarını hız kesmeden sürdüren Keçiören Belediyesi, sahipleri tarafından sokağa terk edilen ya da sokaklarda zor şartlarda yaşayan can dostlar için sıcak yuva bulmaya devam ediyor. Son olarak 3 sokak köpeğinin sahiplendirildiği Pati Yaşam Köyü’nde, sahiplendirme yapılmadan önce can dostların bakım ve tedavileri yapılıyor. Hemogram cihazı, biyokimya analiz cihazı, ultrason cihazı, yoğun bakım üniteleri ve her türlü yumuşak doku ameliyatlarında kullanılacak ekipmanları içinde barındıran Pati Yaşam Köyü Veteriner Kliniği’ndeki veteriner hekimler sokak hayvanlarının tüm tedavileri için seferber oluyor.

[cmcshealth]

Living Donor Kidney Transplant in India

Kidney diseases are on the rise. Lifestyles, dietary habits, and excessive alcohol and tobacco consumption are the major factors responsible for kidney diseases. In India, there are many Kidney transplant specialist surgeons at many better-equipped hospitals to provide successful live donor Kidney transplants. As the awareness and availability of organ donation post-death(deceased Donor) are still in a very nascent stage, Kidney from deceased donors are not readily available and patients suffering from an end-stage renal disease requiring a kidney transplant depend on donation from living family members for live donor kidney transplants. At CMCS Health We are associated with the best and most experienced Kidney transplant surgeons and the best kidney transplant hospitals in India.

Who can be a living donor for a Kidney transplant needing patient in India?

A healthy blood-related family member usually a son or daughter/parents, grandparents and grandchildren, and brothers and sisters are considered blood relations. The donor needs to be a major in the age group of 18-55 years preferably and healthy enough to donate one of his kidneys, without any risk to his quality of life post-donation. Prelim tests for the fitness and compatibility of donors are done for screening and choosing the correct donor for a successful kidney transplant. Any other relative is considered an unrelated donor and certain documents are needed to prove to the Government of India-appointed organ transplant committee that the donor is related to the patient requiring kidney transplant. And donor is willing to donate one of his kidneys to the patient out of love and family bonding and not under any pressure or monetary obligations.

What happens to a Living Donor after a successful Kidney Donation?

A healthy and fit donor lives a perfectly normal life post the donation of one of his kidneys. The doctors do advise him on certain do's and do not post-donation. Anything that is not good for the health of a person with both kidneys functioning normally is also considered bad for the live donor. Regular and periodic checkups are suggested for a live donor. As high blood pressure and diabetes are considered two major causes of kidney function going bad, the donor is advised to follow a healthy lifestyle to remain disease-free.

Does live donors have a health risk or compromised life post-kidney donation?

A healthy donor lives a perfectly normal life, post-donation. Donation of a kidney does not hurt overall life or quality of life for the donor. Selecting the right donor is important as it cuts down the cost of dialysis and the need for frequent admission of patients till the time we get approval from the government of India-appointed transplant committee for kidney transplants. Once the approval is given by the Committee, the patient is given a date and time for surgery. The following tests for donors are required to lessen the chances of flying in the wrong donor and save time and money for guests till we fly in the right donor.

1. Urine ( SPOT), Protein creatinine ratio, LFT (Liver function test), Urea, Creatinine, Sodium(Na), Potassium (K), Blood sugar( Fasting and Postprandial), HBA1C, Calcium (Ca), Phosphate (Po4), Uric Acid, PTH, Lipid profile, Vitamin D level, T3, T4, TSH and LDH.

2. Complete Hemogram, BT, CT, PT, PTTK, and urine routine.

3. Urine culture, CMV-IGG, EBV(CAPSId)_IGG, for MALE patient PSA (if above 50 years of age). for Female patient CA-125 and pap smear.

4. Blood group, HBSAG, Anti HCV antibody, HIV1 & 2, HCV RNA qualitative, Anti-HBS antibody.

5. ECG, Echo/stress echo, Cardiac clearance.

 6. Chest X-ray, Ultrasound-whole abdomen, CT (Angio) for renal vessels, DTPA scan, etc.

CMCS Health is a leading medical tourism company in India. We offer medical tourism services such as finding the right doctor, the right hospital, and cost estimation for medical treatment in India for foreign patients. Some of the main countries are Bangladesh, South Africa, Egypt, Kenya, Saudi Arabia, Ethiopia, Nigeria, Uganda, Zambia, Sudan, Dubai, Namibia, Iraq, and so on. We provide free medical assistance aplastic anemia treatment cost, stomach cancer treatment, sickle cell treatment cost, the best hospital for heart valve replacement, heart valve surgery, arthroscopic surgery, bone marrow transplant cost, best liver transplant hospital, brain tumor surgery cost, cosmetic andplastic surgery, heart surgery, kidney transplant cost,spine tumor surgery,cancer treatment cost, lung transplant,liver transplant cost, top knee replacement surgeons, knee replacement surgery cost, top shoulder replacement surgeons, hip replacement surgery cost, best bone marrow hospital, etc.  If you are searching for free medical and healthcare consulting to find the best hospitals and top doctors and surgeons in India for any treatment then contact us- Cmcshealth.com.

Source: https://cmcshealth1.blogspot.com/2024/11/living-donor-kidney-transplant-in-india.html

[myrawjcsmicasereports]

 Diversity of Radiological Imaging and Clinical Course in Pulmonary MALT Lymphoma  by Aras G1, Zirek Mandal T1, Kanmaz D1, Pehlivan S1, Fener N2, Özbek in Journal of Clinical Case Reports Medical Images and Health SciencesM3.

Abstract :

A 59-year-old male patient was admitted to the emergency department with a three-month history of worsening dyspnea, fatigue, and cough. His vital signs were recorded as follows: blood pressure 138/88 mmHg, heart rate 98 beats/min, respiratory rate 25 breaths/min, temperature 37.8°C, and oxygen saturation 91%. During the lung auscultation, breath sounds were absent in the lower left lung, while crepitant rales were audible in the upper zone and the right lung. CT scan of the chest showed 1 cm lymph nodes, pleural effusion, fibrotic changes, varicose-cystic bronchiectasis, as well as consolidations and atelectasis with air bronchograms in both lungs. Furthermore, thoracic ultrasonography revealed a large effusion in the left hemithorax, measuring 11 cm. He was hospitalized after the placement of a pleural catheter. Radiological diversity and the clinical course of the patient posed challenges for establishing a differential diagnosis. TL; DR: In this paper; we aimed to present a case of MALT lymphoma that manifested in the lung and caused diagnostic confusion with radiological and clinical symptoms.

 Introduction:

     MALT (Mucosa-Associated Lymphoid Tissue) is the lymphoid tissue that plays a role in mucosal defense. It includes functional memory B lymphocytes, which are essential for the immune response. They are not physiologically present in the lungs, but they become active there in response to infections and chronic antigenic stimulation. Marginal zone B-cell non-Hodgkin lymphoma (MALT Lymphoma) accounts for 8% of adult lymphomas. Although it is most commonly seen in the stomach, it can also be seen in the salivary glands, thyroid and lungs (1). It is the most common type of lymphoma in the lung. It presents common radiological, pathological, and clinical findings with infection and other granulomatous diseases, making differential diagnosis quite difficult for the clinician.In this paper, we aimed to present our case, which we had difficulty in diagnosing in the clinic. 

  Case Presentation:

 A 59-year-old male patient was admitted to the emergency department with worsening dyspnea, fatigue, and cough over the past three months. The chest X-ray of the patient showed a consolidation extending from the center to the periphery in the left upper zone near the aortic arch, an increased density indicative of pleural effusion with sinus obliteration on the left, and a consolidation extending from the hilum to the lower zone near the heart edge During the lung auscultation, breath sounds were absent in the lower left lung, while crepitant rales were detected in the upper zone and on the right side. Blood pressure was 138/88 mmHg, pulse was 98 beats /min, respiratory rate was 34 breaths/min, and oxygen saturation was 91%. At the time of admission, the patient's biochemical analysis results were as follows: Glucose 77 mg/dL (normal range: 70-115), urea 31 mg/dL (normal range: 17-43), creatinine 0.77 mg/dL, protein 65.8 g/L (normal range: 66- 83), albumin 39.3 g/dL (normal range: 35-53), LDH 423 U/L (normal range: <247), CRP 21.6 mg/L, procalcitonin <0.01ng/mL, and pro-BNP 8 pg/mL. The hemogram evaluation results were as follows: Leukocyte count 8.27 x 10³/µL, Erythrocyte count 5.16 x 10⁶/uL, Hemoglobin 15.6 g/ dL, Hematocrit (Hct) 48.3%, Platelet count 240,000/uL, Lymphocyte count 2.05 x 10³/uL, Eosinophils 3.4%, and Neutrophil/Lymphocyte ratio 2.47 x 10e3/uL. 

    The patient’s chest CT scan showed 1 cm lymph nodes in the mediastinum, fibrotic changes extending to the pleura, varicose-cystic bronchiectasis, and consolidations and atelectasis with air bronchograms in both lungs. There was also a massive fluid of 11 cm in the left hemithorax. (Figure 2). A thoracentesis was conducted on the patient’s left side following the detection of 13 cm of pleural fluid on thoracic ultrasonography. Lymphocytes, polymorphonuclear leukocytes, and mesothelial cells were observed in the cytological examination of the pleural fluid, but no atypical cells were detected. There was 98% lymphocyte dominance in the cell count. In the biochemical analysis, the pH was 7.440, lactate dehydrogenase (LDH) was 206 U/L, total protein was 39.40 g/dL, albumin was 25 g/dL, glucose was 60 mg/dL, and adenosine deaminase (ADA) was 34.4 U/L. Gram staining of the fluid, bacterial, fungal, and acid-fast bacilli growth were all negative. The patient's fluid was drained by aspiration. An intrapleural catheter was placed due to the high amount of fluid and increased dyspnea. The patient was admitted to the ward and initiated on oxygen therapy, bronchodilators, and antibiotics. The pleural fluid sent for cytological analysis two more times during the patient's hospitalization was found to be serohemorrhagic. Upon reevaluating his microbiological results, no growth was observed. Although many lymphoid cells were seen in the cytopathological examination of the patient's second pleural fluid, no atypical features were monitored. The patient's condition stabilized during clinical follow-up, and the pleural catheter was removed. However, after a while, the patient's dyspnea complaint recurred and the catheter was placed again because of the increase in fluid on the radiograph (Figure 3). There was no change in the infection markers of the patient, who also had fever from time to time, and CRP ranged between 20 and 16 mg/dL during follow-up. There was no growth in his small amount of sputum and blood cultures taken during the fever. The patient underwent fiberoptic bronchoscopy and no endobronchial lesions were detected. Wang fine needle aspiration and bronchial lavage were applied to mediastinal lymphadenomegaly Wang IA revealed lymphoid cells, but a definitive diagnosis could not be obtained. No findings were found in the lavage other than bronchial epithelial cells and polymorphonuclear leukocytes

    No FDG uptake was detected in the pleural fluid during the patient's whole-body positron emission tomography (PET-CT) scan, though minimal FDG uptake was observed in certain pleural areas. Consolidated/ground glass foci with the focal lepidic appearance in places were detected with left lung lingular, lower lobe central SUVmax 9.14, and right lung lower lobe SUVmax 6.55 and were evaluated to be in favor of malignant processes. Abdominal ultrasonography was unremarkable. No extrapulmonary findings were monitored in PET-CT scan either.

    When Wang IA did not yield any results, endoscopic ultrasonographic bronchoscopy (EBUS) was performed. The pathological interpretation was in favor of granulomatous inflammation, as mature transformed lymphocytes, polymorphonuclear leukocytes, epithelioid histiocytes, and loose granuloma-like structures formed by epithelioid histiocyte clusters and multinucleated giant cells were observed in the materials obtained. Alveolar sarcoidosis was taken into account, but the serum angiotensin converting enzyme level was also found to be normal at 39.1 U/L (8- 52.0).

    The patient was discharged due to the clinical stability of the patient with CRP 3.2 and procalcitonin <0.01 and was called for a follow-up at a later date. In the meantime, the patient was discussed at the surgical council. A decision was made to perform video-assisted thoracoscopy due to the fluid not regressing, increased dyspnea, and malignant involvement in PET-CT.

    During the procedure conducted under general anesthesia, 400 cc of fluid was aspirated. Biopsies were obtained from two distinct areas of the pleura and from a nodular region on the diaphragm, followed by talc pleurodesis. Samples were sent to microbiology and pathology. The patient, having experienced no complications, was discharged following the procedure . Pathology: Samples taken from the parietal pleura and the nodule on the diaphragm were evaluated as low-grade non-Hodgkin Lymphoma and interpreted as extra-nodal marginal zone lymphoma (MALT) by the pathologist .

Discussion 

    Clinical: The patient, who had been admitted to the emergency room with symptoms of dyspnea, hypoxia, and fever, was hospitalized after pleural fluid was exudate and consolidation was detected. Although the patient's clinical symptoms were severe, CRP was moderately high, and the occasional fever despite antibiotic therapy during hospitalization suggested diagnoses such as malignancy and tuberculosis, in addition to non-specific infection. Lymphomatous proliferation can involve the lung in various ways. Non-Hodgkin or Hodgkin lymphoma can present in the lung through hematogenous spread or by invading from adjacent mediastinal lymph nodes. However, primary involvement of the lung is also possible. Primary lymphomas should not have extra-pulmonary organ involvement for at least 3 months after diagnosis. The most common are MALT and effusion lymphomas (2). Effusion lymphomas may involve the pericardial and peritoneal cavities, with the most common primary involvement being the pleura, without solid organ involvement. Human-Herpes-8 infection and EBV may be accompanied by fever and lymphocytic-exudative fluid. HHV-8 negative cases have a better prognosis (3). In this case, there was also an exudative pleural effusion. However, although pleural involvement was not detected in the fluid cytological examination, pleural involvement was detected in biopsies. However, it is not possible to say that the patient only has effusion lymphoma (PEL). MALT (Mucosa-associated Lymphoid Tissue) lymphoma is the type of lymphoma that most commonly involves pulmonary tissue, is often asymptomatic, and shows radiological alveolar opacities. Although it is more commonly affected in people aged 50-60, it can rarely be seen under the age of 30. It constitutes 60% of pulmonary lymphomas. Weight loss and fever are especially prominent during the aggressive phase, though the condition may initially be asymptomatic. Autoimmune disease may be the basis in 16% of cases (1,4). The prognosis of MALT lymphomas is good; 5–10-year survival is more than 80% (5).

   Radiological: 

MALT lymphoma exhibits radiological variability, appearing as single or multiple bilateral lesions on both chest radiography and thoracic tomography. Chronic alveolar localized opacities smaller than 5 cm on radiography are accompanied by consolidation in 50% of cases. Diffuse reticulonodular opacity, atelectasis, and pleural effusion are detected in less than 10% of cases (1). In our case, there was also pleural fluid along with similar findings. Findings such as consolidation (60-77%) with air bronchogram and increased vascularity or multiple mass nodules, ground glass, halo sign, galaxy sign specific to tuberculosis and sarcoidosis have been reported in case series and reports. In addition, varicose cystic bronchiectasis secondary to consolidation can be detected. However, it is not possible to state that these findings are specific to MALT lymphoma. These radiological images are also observed in adenocarcinoma, pneumonia, metastases, sarcoidosis, and tuberculosis (6,7). In this case, chest X-ray revealed bilateral multifocal consolidation and densities indicative of pleural effusion. Consolidation, pleural effusion, varicose cystic bronchiectasis changes and mediastinal lymphadenomegaly were detected on thoracic tomography. None of these radiological findings were specific to lymphoma and diagnosis could not have been made without pathological examination. The partial alleviation of the patient's clinical symptoms compared to the beginning and the patient's relief with the drainage of the pleural fluid suggested possibilities such as infection, alveolar sarcoidosis, or adenocarcinoma when we did not have pathological data. Nevertheless, when intermittent fevers began to occur during the clinical course, it was obvious that lymphoma could not be excluded from the diagnosis. No endobronchial lesion was detected in the bronchoscopy performed on the patient; Wang fine needle aspiration and then endobronchial ultrasonographic biopsy were performed for mediastinal lymphadenomegaly. The sensitivity and specificity of positron emission tomography (PET-CT) in lymphoma varies according to organ involvement. It has been reported as 80-100% in lung involvement (8, 9). In our case, high SUVmax FDG uptake in consolidated foci in lepidic structure was monitored in PET-CT, and pleural uptake was minimal. The presence of clinical symptoms and high FDG uptake necessitated a video-assisted-thoracoscopic (VATS) procedure.

Pathological: 

    In the pleural fluid sample examined at the start of the treatment, abundant lymphoid cells were detected, but no atypical structures were observed. There were findings of granulomatous inflammation in the samples obtained from the mediastinal lymph nodes of the patient. In fact, in the biopsy samples taken by video-assisted thoracoscopy, lowgrade B-cell non-Hodgkin Lymphoma (CD20 positive (diffuse cells), anti-BCL-2 positive, anti Ki-67 low positive) and extranodal marginal zone lymphoma were detected in the parietal pleura. Pathologically, the lymphomatous infiltrate in MALT lymphoma exhibits heterogeneous features and consists of small lymphocytes, centrocyte-like cells, monocytoid B cells, rarely large transformed cells and plasma cells (10). Necrosis is rare. Neoplastic cells are expressed in CD 20 and CD 79. Ki67 index is lower than 20%. Lymphoma and sarcoidosis are similar in terms of clinical and radiological phenotype. Distinguishing lowgrade lymphomas from sarcoid lesions can be challenging; sarcoid granulomatous lesions may be accompanied by lymphoid cell infiltration. In addition, sarcoid-like reactions are frequently seen in malignant lymphomas. Moreover, sarcoidosis-lymphoma syndrome was first described in the study by Brincker et al. They reported that lymphoma was 5.5 times more common in sarcoidosis patients than in the general population, indicating the presence of sarcoidosis years before lymphoma (11, 12). Kokuho N et al reported MALT lymphoma in the lung for the first time in a ten-year-old sarcoidosis case with ocular, gastric and lung involvement (13). In this case, granulomatous inflammation was detected in mediastinal LAMs, but no findings of sarcoidosis were found in ocular, cardiac, renal examinations, angiotensinconverting enzyme, calcium, alkaline phosphatase, and 24- hour urine calcium analyses. There was also no abnormality in abdominal ultrasonography. We believe that the granulomatous inflammation in our case was reactive to immune deficiency.

    Conclusion The patient was started on Rituximab treatment by the hematology department. Clinical and radiological improvement was observed following treatment. In the follow-up PET-CT examination, regression in consolidated areas, decrease in FDG uptake, and metabolic partial regression were detected compared to the initial examination (Figure 6). Lymphomas, which do not have specific radiological and symptomatic features, can mimic most diseases of the respiratory system and do not present with a noisy picture, requiring the clinician to be persistent in making the diagnosis.

References:

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