ABSTRACT
Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of a vascular origin which can arise in different locations such as the lungs, liver, soft tissue, and rarely, in the bones. In the lungs, pulmonary hemangioendothelioma (PEH) shows a variable clinical behavior, displaying a range from either an asymptomatic course to a highly aggressive progression with metastases. Based on radiological features, PEH differential diagnosis mainly includes primary or metastatic lymphangitic carcinomatosis, granulomatous infections, and diffuse interstitial lung diseases where ground glass pattern predominates. In this case, a transbronchial biopsy and subsequent histological and immunohistochemical analysis allowed for the attribution of the scenario to a pulmonary epithelioid hemangioendothelioma. Clinicians should always consider bronchoscopy as a useful and effective tool to better investigate indeterminate and questionable clinical pictures, sparing patients the morbidity and mortality associated with more invasive techniques such as surgical or thoracoscopic biopsy.
ABSTRACT
Introduction: Ultrasound guided sampling (USGS) of supraclavicular lymph nodes (SCLN) is a minimally invasive method for obtaining cytological diagnosis in metastatic lung cancer. Same day USGS service may improve timeliness of investigations, minimise hospital visits and reduce invasive procedures. Methods: We performed a 3-year retrospective analysis of patients with SCLN amenable to biopsy detect-ed on 2 week-wait (2WW) CT. We identified those who underwent USGS or other procedures, diagnostic yield and their timeliness were determined. Results: 49 patients (26%) had amenable SCLN, of whom 37 (75.5%) had USGS. USGS alone sufficient for 27 (73%) patients. Diagnostic yield is better for larger nodes (<1cm 62.5% positive;≥1cm 86.2% positive, 95% CI 0.13-0.93, p=0.011). The overall diagnostic yield of USGS SCLN was 81% (30/37, 95% CI 65% to 92%). Al-though faster to obtain USGS, no statistically significant difference was reached between USGS and other methods (USGS median 15.5 days (IQR 11.2), other procedures median 17.5 days (IQR 26.5), Mann-Whitney U p=0.42). Conclusion: USGS SCLN has potential utility in early lung cancer diagnosis, even in lymph nodes <1cm, and is an underutilized diagnostic investigation. A prospective study of same day 2WW outpatient clinic and USGS procedure is now required to assess its effect on an accelerated diagnostic pathway. © 2022, Zita Medical Managent. All rights reserved.