Atypical Manifestations of Primary Pulmonary Adenocarcinoma With Signet Ring Features: A Case Report.

Primary pulmonary malignancies are one of the most common malignancies worldwide. The most common non-small cell lung malignancy is adenocarcinoma, but there are many subtypes with different molecular and genetic expressions causing different manifestations. Uncommon manifestations include persistent back pain and tracheal bronchial tumors. More than 95% of reported tracheal bronchial tumors are benign and thus are rarely biopsied. There are no reported cases of secondary tracheal bronchial tumors due to pulmonary adenocarcinoma. Today, we are reporting the first case report of an uncommon manifestation of primary pulmonary adenocarcinoma.

Obstructive Sleep Apnea and Pulmonary Hypertension: A Review of Literature.

Obstructive sleep apnea (OSA) is a disease process involving recurrent pharyngeal collapse during sleep, resulting in apneic episodes. Clinically, symptoms can include snoring, sudden awakening with a choking-like sensation, excessive somnolence, non-restorative sleep, difficulty in starting or maintaining sleep, and fatigue. It results in impaired gas exchange, subsequently causing various cardiovascular, metabolic, and neurocognitive pathologies. Historically, OSA has been underdiagnosed and undertreated, especially in women. OSA is associated with WHO (World Health Organization) class III pulmonary hypertension (PH) or PH due to lung disease. PH is a concerning complication of OSA and thought to occur in roughly 20% of individuals with OSA. The pathogenesis of PH in OSA can include pulmonary artery vasoconstriction and remodeling. Patients suffering from OSA who develop PH tend to have worse cardiovascular and pulmonary changes. We present a thorough review of the literature examining the interplay between OSA and PH.

Limited Scleroderma-Induced Pulmonary Arterial Hypertension Resulting in Impaired Postoperative Respiratory Function.

Limited scleroderma falls under the umbrella of systemic sclerosis, an autoimmune disease that presents with multiorgan dysfunction that includes pulmonary arterial hypertension. We examine a case of pulmonary arterial hypertension in an elderly nonsmoker with a history of limited scleroderma.  The patient presented with abdominal tenderness and was diagnosed with a sigmoid colonic stricture. She underwent laparoscopic bowel resection. During and after her surgery, she suffered from worsening respiratory function and decompensated, developing a large pleural effusion that led to a thoracentesis and a prolonged hospital course. Patients with scleroderma can develop acute symptoms involving several organ systems, including the colonic tract and lungs, as seen in our patient. A thorough workup and continuous close management and monitoring are necessary to avoid further complications in these patients, especially in the postoperative period.

Thymoma Presenting as a Pleural-Based Mass.

We present a unique case of a satellite pleural-based thymoma. The patient is a 66-year-old Caucasian female with a history of a left pericardial soft tissue mass. She had been asymptomatic. Chest radiograph incidentally revealed an acute increase in the size of the mass. CT scan identified a 5.6 X 5.2 X 4.2 cm mediastinal mass in the left infrahilar region along the left lateral pericardium. Positron emission tomography (PET) scan showed the mass had an increased F18 FDG uptake with standardized uptake value (SUV) of 7.2. Left thoracotomy resected a 81g, 6 X 5.5 X 5.0 cm tan-pink well-encapsulated pedunculated mass displacing the left phrenic nerve. The mass was under the parietal pleura and not attached to the pericardium. Immunohistochemical profile identified the tumor as a thymoma, B1 type. Thymomas are relatively rare in the United States, pleural-based thymomas even more so. Early detection of thymomas is critical to avoid late-stage growths. Pericardial involvement of thymomas increases risk of pericardial effusion, tamponade and a complicated thymectomy. Pleural-based thymomas can result in diaphragmatic paralysis secondary to phrenic nerve involvement.