A novel case of left atrial and right lung mass turned out to be unconventional metastasis of uterine leiomyosarcoma with a review of literature

Uterine leiomyosarcoma (ULMS) is a rare malignancy arising from the myometrial smooth muscle wall, and cardiac metastases are extremely rare. Metastasis to the heart is a very unusual finding, and atrial metastasis is even rarer. Here, we report a case of a 45 year old woman who presented with dyspnea and pleural effusion and had a significant history of hysterectomy done for ULMS. Magnetic resonance imaging revealed a left atrial mass, which was resected and revealed to be a metastasis of leiomyosarcoma on histopathology and immunohistochemistry. Metastatic ULMS may rarely present as a left atrial mass with acute clinical presentation. Detailed clinical history and accurate diagnosis are vital for further management.

Neumonía lipoidea exógena no fibrosante: a propósito de un caso / Non-Fibrosing Exogenous Lipoid Pneumonia: presentation of a case

La neumonía lipoidea exógena (NLE) es una patología inusual, que tiene una incidencia del 1% al 2,5%, y tiene su causa en la aspiración y la acumulación de lípidos de origen exógeno dentro de los alvéolos pulmonares. Cuando el agente aspirado es de composición oleosa, se desencadena una reacción inflamatoria pulmonar denominada neumonía lipoidea, que con el tiempo puede conducir a una fibrosis parenquimatosa irreversible. En ocasiones, se puede presentar en forma de lesiones nodulares, que obligan a un amplio diagnóstico diferencial, en el que desempeñan un papel fundamental los estudios por imágenes. Para el diagnóstico definitivo, se requiere confirmación histopatológica1. Presentamos un caso clínico de neumonía lipoidea que se presentó como masa pulmonar acompañada de infiltrados pulmonares bilaterales.

Exogenous lipoid pneumonia (ELP) is an unusual disease, with an incidence of 1 to 2.5%, caused by aspiration and accumulation of exogenous lipids in the pulmonary alveoli. When the aspirated agent has an oily composition, a pulmonary inflammatory reaction called lipoid pneumonia is triggered, which over time can lead to irreversible parenchymal fibrosis. Sometimes it can appear as nodular lesions that require a broad differential diagnosis, in which case imaging studies have a fundamental role. Histo pathological confirmation is required for definitive diagnosis1. We present a clinical case of lipoid pneumonia which appeared as a lung mass ac companied by bilateral pulmonary infiltrates.

Non-Fibrosing Exogenous Lipoid Pneumonia: presentation of a case / Neumonía lipoidea exógena no fibrosante: a propósito de un caso

ABSTRACT Exogenous lipoid pneumonia (ELP) is an unusual disease, with an incidence of 1 to 2.5%, caused by aspiration and accumulation of exogenous lipids in the pulmonary alveoli. When the aspirated agent has an oily composition, a pulmonary inflammatory reaction called lipoid pneumonia is triggered, which over time can lead to irreversible parenchymal fibrosis. Sometimes it can appear as nodular lesions that require a broad differential diagnosis, in which case imaging studies have a fundamental role. Histopathological confirmation is required for definitive diagnosis1. We present a clinical case of lipoid pneumonia which appeared as a lung mass accompanied by bilateral pulmonary infiltrates.

RESUMEN La neumonía lipoidea exógena (NLE) es una patología inusual, que tiene una incidencia del 1% al 2,5%, y tiene su causa en la aspiración y la acumulación de lípidos de origen exógeno dentro de los alvéolos pulmonares. Cuando el agente aspirado es de composición oleosa, se desencadena una reacción inflamatoria pulmonar denominada neumonía lipoidea, que con el tiempo puede conducir a una fibrosis parenquimatosa irreversible. En ocasiones, se puede presentar en forma de lesiones nodulares, que obligan a un amplio diagnóstico diferencial, en el que desempeñan un papel fundamental los estudios por imágenes. Para el diagnóstico definitivo, se requiere confirmación histopatológica1. Presentamos un caso clínico de neumonía lipoidea que se presentó como masa pulmonar acompañada de infiltrados pulmonares bilaterales.

Tumor fibroso solitario de la pleura / Solitary fibrous tumor of the pleura

El tumor fibroso solitario de la pleura (TFSP) representa una neoplasia benigna de evolución habitualmente silente, hallazgo incidental y heterogeneidad en su presentación. Raramente se malignizan y la sintomatología se relaciona fundamentalmente con el compromiso por compresión de las estructuras vecinas. Su tratamiento es la cirugía. Se describe el caso de un paciente masculino de 49 años con antecedentes de hipertensión arterial, diabetes mellitus y obesidad que consultó al Servicio de urgencias por disnea. Se solicitó tomografía de tórax que evidenció voluminosa masa de densidad de partes blandas en hemitórax izquierdo con desplazamiento del mediastino y descenso del diafragma del mismo lado. La fibrobroncoscopia no evidenció lesión endoluminal. Fue evaluado por Cirugía del Tórax. Se realizó abordaje de la masa mediante toracotomía postero lateral izquierda. El estudio anatomopatológico informó formación tumoral de 25 × 16 × 13 cm, peso de 1905 gr y en la microscopía se describió proliferación celular fibroblástica, células fusiformes de núcleos pequeños ovoides y escaso citoplasma dispuestas en haces desordenados con colágeno interpuesto. La inmunohistoquímica informó vimentina y CD34 positivos. Se realizó el diagnóstico de tumor fibroso solitario de la pleura. La evolución posterior fue buena.

The solitary fibrous tumor of the pleura (SFTP) represents a benign neoplasm of commonly silent evolution, incidental finding and heterogeneous presentation. It rarely becomes malignant and symptoms mainly result from the involvement of neighboring structures due to compression. It is treated with surgery. We describe the case of a 49-year-old male patient with history of arterial hypertension, diabetes mellitus and obesity who consulted the Emergency Services because he was experiencing dyspnea. We requested chest tomography that showed a voluminous soft tissue density mass in the left hemithorax with mediastinal shift and decreased diaphragm on the same side. The fibrobronchoscopy didn't show endoluminal lesion. The patient was evaluated by the Thorax Surgery staff. The mass was treated by means of left posterolateral thorachotomy. The anatomopathological study reported the formation of a tumor of 25 × 16 ×13 cm and 1905 gr, and the microscopy described fibroblast cell proliferation, spindle cells of small ovoid nuclei and very little cytoplasm placed in disorganized bundles with collagen interposition. The immunohistochemistry disclosed positive vimentin and CD34. The patient was diagnosed with solitary fibrous tumor of the pleura, with good subsequent evolution.

Diagnostic efficacy of FNAC by liquid based technique versus conventional smear in lung and mediastinal masses

Background: Fine Needle Aspiration Cytology (FNAC) has proven to be less costly and less invasive procedure than biopsy for diagnosing benign and malignant lesions. Of the two methods liquid based cytology (LBC) and conventional cytology (CC), LBC has been standardized as more efficacious in reporting in Gynaecological cases. But, this is still lacking in non-gynaecological cases and many studies are now focusing on studying LBC due to its proven advantages in Pap smear evaluation.Methods: An observational study of 72 patients with lung mass and 11 with mediastinal mass was done for a period of six months in a tertiary care hospital in Gurugram to compare the diagnostic efficacy of LBC and CC in fine needle aspirates from lung/mediastinal mass.Results: Of the 83 cases, reporting of LBC was adequate in 75 cases and CC in only 53 cases. LBC was better when differentiating malignant and benign lesions than CC. CC smears had better cellularity in comparison to LBC smears (36%), but rest cytological features of cytoplasmic detailing, cell architecture, less background debris and blood were all more appreciable in LBC smears than CC preparations.Conclusions: LBC is a better method than conventional smear for smear preparation and processing of aspirates obtained from lung and mediastinal mass.

Computed Tomography Guided Fine Needle Aspiration Cytology of Lung and Mediastinal Lesions

Introduction: Computed tomography guided fine needleaspiration cytology is a safe and well established technique forthe diagnosis of lung and mediastinal lesions. This study wascarried out in the department of pathology in the tertiary healthcare and teaching institute where radiology department is wellestablished. The aim was to study the cytomorphology of thespectrum of the lung and mediastinal lesions and to correlatethe cytological diagnosis with the radiological diagnosis.Material and methods: Computed tomography guided fineneedle aspiration cytology was done in 90 pateints after takingwritten consent of the patient. Patients were explained thebenefits and risks of the procedure. The results were analysed.Results: A total of 90 patients were included in the study.There were 81 patients of lung lesions and nine patients ofmediastinal lesions. There were 63(70%) males and 27(30%)females. Adequate aspirate was obtained in 77 patientsgiving the adequacy rate of 85.55%. Adenocarcinomawas the most common type of lung malignancy and NonHodgkins Lymphoma was the most common malignancyin the mediastinum. Inflammatory lesions were seen in 13cases. Granulomatous lesions were found in six patients. Oneinteresting case of hydatid with aspergillosis was diagnosedon cytology smears, which on radiology was diagnosed asneoplastic. Pneumothorax was seen in three patients. Nopatient required chest tube insertion.Conclusion: Computed tomography guided fine needleaspiration cytology is a safe and reliable method for thediagnosis of lung and mediastinal lesions. It can help inearly diagnosis and initiation of the treatment avoiding majorsurgical procedures.

Magnetic resonance imaging in the diagnosis of large shadow of coal workers' pneumoconiosis and its clinical application / 中国职业医学

OBJECTIVE: To evaluate the clinical application of magnetic resonance imaging( MRI) in diagnosis of lung large shadow in coal workers' pneumoconiosis( CWP). METHODS: Twenty-five CWP patients with lung large shadow( 39 lesions) were selected as CWP group by using the judgment sampling method,and 34 cases( 34 lesions),including 21 cases of lung cancer( lung cancer subgroup) and 13 cases of lung mass( lung mass subgroup),were selected as control group. Routine MRI examinations was performed on these three groups of patients. T1 weighted imaging( T1 WI),T2 weighted imaging( T2 WI) and frequency pre-saturation inversion recovery( SPIR) imagings were performed to analyze the differences of MRI images. RESULTS: Large shadow lesions in patients with CWP showed slightly lower signal,equal signal and equal lower signal in T2 WI and SPIR,accounting for 97. 4%(38/39) and 94. 9%(37/39) respectively. Those show slightly higher signal accounted for 2. 6%(1/39) and 5. 1%(2/39),respectively. The proportions of lung large shadows showed slightly higher signal of CWP group at T2 WI and SPIR were lower than those in the control group( 2. 6% vs88. 2%,5. 1% vs 91. 2%,P < 0. 01),the lung cancer subgroup(2. 6% vs 95. 2%,5. 1% vs 95. 2%,P < 0. 01) and lung mass subgroup( 2. 6% vs 76. 9%,5. 1% vs 84. 6%,P < 0. 01). CONCLUSION: MRI has good specificity in identifying characteristics of lesion of CWP large lung shadow. The main manifestations are slightly lower signal,equal signal and equal lower signal on T2 WI and SPIR

Computerized tomography guided percutaneous transthoracic fine needle aspiration of lung lesions

Introduction: Computed tomogram guided fine needle aspiration cytology (FNAC) is an important and useful investigation to differentiate between benign and malignant lesions of lungs. With computed tomography (CT) it is possible to perform a biopsy on almost any portion of lung with high degree of safety and minimal morbidity avoiding more invasive techniques. Aim: The present study was designed to assess the efficacy of CT guided fine needle aspiration of lung lesions and to assess the incidence of complications. Materials and methods: 65 cases of both sex and varying age groups referred to radiology department for CT guided lung FNAC from October 2012 to January 2013 were included in this study. Relevant clinical history and investigations were obtained from the patient. Informed and written consent was taken from the patient. The lesions were localized by CT scan and after the needle tip was confirmed to be in the desired location, aspirations were performed. Results: A total 65 cases, 53 cases were male and 12 cases were female with mean age 49.23 years. The most common diagnosis observed following biopsy was malignancy (non small cell carcinoma) in 41 cases (63%), benign lesion in 6 cases (9%) and 3% showed mixed lesions. Among 65 cases, 49 cases (75%) showed adequate material in the aspirate specimen, where as 12 cases (18.4%) showed inadequate tissue for diagnosis. However 4 cases were lost on follow up. Complications observed during procedure include pneumothorax in 11 cases (16.9%) and hemoptysis/pulmonary hemorrhage in 2 cases (3%). Conclusion: CT guided FNAC is well recognized procedure with good efficacy for evaluation of pulmonary lesions with minimal complications, most common being pneumothorax followed by hemoptysis.

A Case of Extramedullary Hematopoiesis Presenting as a Lung Mass in a Patient with Primary Myelofibrosis / 결핵및호흡기질환

Primary myelofibrosis is characterized by replacement of bone marrow with fibrotic tissue and the development of extramedullary hematopoiesis. Extramedullary hematopoiesis primarily involves the spleen and liver, but can also occur in the lungs. We report the case of an 80-year-old male who was admitted for evaluation of a lung mass and persistent thrombocytopenia. A percutaneous needle aspiration from the mass in the right lower lung showed myelopoietic cells with fatty tissue. A bone marrow biopsy revealed a hypercellular marrow with an increased number of atypical megakaryocytes. The final diagnosis was a prefibrotic stage of primary myelofibrosis leading to extramedullary hematopoiesis in the lung.

A Case of Wegener's Granulomatosis that Presented as a Single Lung Mass / 결핵및호흡기질환

Wegener's granulomatosis is a disease with an unknown etiology that is characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tract and the kidneys. The typical pulmonary findings are bilaterally involved multiple variable sized nodules. We report a case of Wegener's granulomatosis that presented as a single lung mass. A male patient presented with a nasal obstruction, arthralgia, cough, and intermittent dyspnea. The chest radiograph showed a mass, approximately 4.5 cm in diameter, in the right lower lobe. Lung cancer or tuberculosis was initially considered. However, the clinical, laboratory and pathological findings of the mass indicated Wegener's granulomatosis. The patient was administered prednisolone and cyclophosphamide, and improved temporarily. Unfortunately, the immunocompromised patient expired as a result of respiratory failure with pneumonia.

A Case of Lymphangioleiomyomatosis Presenting as a Lung Mass / 결핵및호흡기질환

Lymphangioleiomyomatosis (LAM) is a rare disease that affects females of reproductive age. It is characterized by the abnormal proliferation of smooth muscle cells in the lung and along the axial lymphatics. We report a case of lymphangioleiomyomatosis presenting as a lung mass. The patient visited the emergency room because of dyspnea upon exertion. The chest X-ray showed a lung mass in the right lower lung field and a pneumothorax in the left lung. Chest computed tomography revealed a 5 x 3 cm sized mass in the right lower lobe and multiple thin-walled small cysts scattered in both lungs. Transbronchial biopsy of the lung mass was performed. The biopsy specimen showed atypical smooth muscle cell proliferation and cystic dilatation of the terminal bronchioles, which confirmed the diagnosis of lymphangioleiomyomatosis. To the best of our knowledge, this is the first case of lymphangioleiomyomatosis presenting as a lung mass.

Mycobacterium Kansasii Disease Presenting As a Lung Mass and Bronchial Anthracofibrosis / 결핵및호흡기질환

The incidence of Mycobacterium kansasii pulmonary diseases are on the increase in Korea with the higher probability of occurrence in middle-aged and older men with underlying lung diseases Among nontuberculosus mycobacterial (NTM) infections, the clinical features of M. kansasii pulmonary infection are most similar to those of tuberculosis (TB). The chest radiographic findings of M. kansasii infection are almost indistinguishable from those of M. tuberculosis (predominance of an upper lobe infiltration and cavitary lesions), even though some suggest that cavities are more commonly thin-walled and have less surrounding infiltration than those of typical TB lesions. Although there are reports on the rare manifestations of M. kansasii infections, such as endobronchial ulcer, arthritis, empyema, cutaneous and mediastinal lymphadenitis, cellulites and osteomyelitis, the association with bronchial anthracofibrosis has not yet been reported. This report describes the first case of M. kansasii infection presenting as a lung mass in the right lower lobe with accompanying bronchial anthracofibrosis.