Pulmonary sclerosing pneumocytoma masquerading adenocarcinoma with co-existing BRAF V600E and PTEN mutation.

We report a case of a massive primary sclerosing pneumocytoma (PSP) involving the right lower lobe adhering esophagus with small synchronous PSP on the superior segment of the left lower lobe with concurrent mutation for B-RAF proto-oncogene, serine/threonine kinase (BRAF V600E), and phosphatase and tensin homolog (PTEN) gene in a young female. She underwent right lower lobectomy and mediastinal lymph node dissection under single lung ventilation with tumor-free margins on diagnosis-based findings of preoperative computed tomography-guided biopsy and positron emission tomography. Histopathology was suggestive of PSP-papillary variant with concurrent mutation of BRAF V600E and PTEN genes. Post-operative follow-up at four weeks was uneventful. She has to undergo wedge resection for the contralateral disease after six weeks following recovery from the first surgery.

Lung Perfusion Scintigraphy Early After COVID-19: A Single-Center Retrospective Study.

The incidence of thromboembolic complications in coronavirus disease 2019 (COVID-19) infection is well recognized. The present study retrospectively evaluated the type and prevalence of lung perfusion defects in early-post-COVID-19 patients with hypoxia and was aimed to identify the risk factors for mismatched perfusion defects. Methods: We analyzed SPECT/CT images of 54 early-post-COVID-19 patients (44 men and 10 women). Logistic regression analysis was used to examine the risk. Results: The mean age of the study population was 55.4 y (range, 34-76 y). All received prophylactic anticoagulation from the day of hospitalization to the date of perfusion scanning. The median interval between COVID-19-positive reports and lung perfusion scanning was 22 d. Lung perfusion defects (of any type) were observed in most (87%). Twenty-three subjects (42.6%) had mismatched perfusion defects. Mismatched perfusion defects were segmental in 14 subjects (25.9%) and subsegmental in 11 (20.4%). Higher age was a risk factor for mismatched perfusion defects (odds ratio, 1.06; 95% CI, 0.99-1.13; P = 0.06). Subjects with a serum D-dimer level of at least 2,500 ng/mL on the day before the scan were not at higher risk for having mismatched perfusion defects (odds ratio, 1.14; 95% CI, 0.34-3.9; P = 0.83). Conclusion: Despite prophylactic anticoagulation, mismatched perfusion defects suggestive of pulmonary thromboembolism were observed. Serum D-dimer level in patients early after COVID-19 is a poor predictor of mismatched perfusion defects. Confirmed evidence of pulmonary embolism by imaging studies should support the decision to extend anticoagulant prophylaxis in post-COVID-19 patients.