Paraneoplastic cushing’s syndrome: A diagnostic and therapeutic challenge: A case report and literature review

Ectopic Cushing syndrome (ECS) is difficult to diagnose and has a poor prognosis. We report a case of a 44-year-old male who was admitted for clinical suspicion of Cushing’s syndrome. The investigations confirmed the diagnosis of ECS. No tumor was detected in preliminary imaging tests. Then, the octreoscan showed a fixation in a suspect lung node in the middle lobe. The patient was treated initially with medical drugs, he underwent a right middle lobectomy, and yet histopathology did not reveal any nodule. However, the outcome was the healing of our patient. We reviewed published articles to access new diagnostic techniques or advantages in the treatment regimen and a prognosis of ECS. Keywords: ectopic cushing’s syndrome; paraneoplastic syndromes; lung cancer.

Automatic detect lung node with deep learning in segmentation and imbalance data labeling

In this study, a novel method with the U-Net-based network architecture, 2D U-Net, is employed to segment the position of lung nodules, which are an early symptom of lung cancer and have a high probability of becoming a carcinoma, especially when a lung nodule is bigger than 15 $$\mathrm{mm}^2$$ mm 2 . A serious problem of considering deep learning for all medical images is imbalanced labeling between foreground and background. The lung nodule is the foreground which accounts for a lower percentage in a whole image. The evaluation function adopted in this study is dice coefficient loss, which is usually used in image segmentation tasks. The proposed pre-processing method in this study is to use complementary labeling as the input in U-Net. With this method, the labeling is swapped. The no-nodule position is labeled. And the position of the nodule becomes non-labeled. The result shows that the proposal in this study is efficient in a small quantity of data. This method, complementary labeling could be used in a small data quantity scenario. With the use of ROI segmentation model in the data pre-processing, the results of lung nodule detection can be improved a lot as shown in the experiments.

Lymphomatoid Granulomatosis of Central Nervous System and Lung Driven by Epstein Barr Virus Proliferation: Successful Treatment with Rituximab

Lymphomatoid granulomatosis (LYG) is a very rare Epstein-Barr virus (EBV) associated B-cell lymphoproliferative disorder. We report the case of a 41-year-old man who presented with fever and respiratory symptoms. Computed tomography showed multiple nodules in both lung fields. Polymerase chain reaction (PCR) analysis of the bronchoalveolar lavage was positive for EBV and biopsy of lung node yielded a diagnosis of LYG, grade III. Shortly after initiation of treatment with chemotherapy, neurologic deterioration appeared. Radiologic findings revealed hydrocephalus and PCR analysis of the cerebrospinal fluid (CSF) was positive for EBV. Treatment with intravenous rituximab led to rapid reduction of EBV load in CSF, along with radiological and clinical improvement. After completion of treatment with immunochemotherapy, an autologous stem cell transplantation was performed. Patient stays in remission one year after diagnosis.