RESUMO
Low-grade fibromyxoid sarcoma (LGFMS) is a rare subclass of sarcoma. Histologically, they are characterized by bland-appearing fibroblastic spindle cells and are similar to sclerosing epithelioid fibrosarcoma (SEF) subtype. The standard treatment of this aggressive tumor subtype is surgical removal with wide excision in conjunction with doxorubicin chemotherapy. Due to the rarity of this disease, effective systemic therapies are lacking and patient outcomes remain poor. Herein, we report on a 50-year-old male who presented with severe shortness of breath. Subsequent imaging revealed pericardial effusion and large mediastinal mass consistent with locally advanced disease. Fine needle biopsy demonstrated malignant, Ewing-like round tumor cells. Further genetic analysis affirmed the presence of FUS-CREB3L2 gene fusion. The patient was treated with doxorubicin and survival time from the initial presentation was five months. To date, there are limited reports of this disease. Few targeted therapies or immunotherapies for LGFMS exist, and a dire need for new therapy development remains.
RESUMO
Hot tub lung (HTL) is a granulomatous lung disease thought to occur as a result of a hypersensitivity response to non-tuberculous mycobacteria (NTM). Typical radiographic findings are diffuse micronodular and/or ground glass opacities. We report an interesting case of HTL that presented with unique radiographic features, making its diagnosis a predicament. A 56-year-old immunocompetent female with chronic dyspnea and dry cough was found to have subcentimeter cavitary nodules, predominantly in the upper lung zones. Tissue culture obtained via bronchoscopy was positive for Mycobacterium avium complex (MAC). The patient's clinical and radiographic status, however, deteriorated on antimycobacterial therapy. Complete clinical and radiographic resolution was achieved only after avoidance of hot tub use and treatment with steroids. We believe this is the first reported case of HTL manifesting as cavitary lung nodules with mediastinal lymphadenopathy, and we recommend physicians keep HTL in consideration when encountering patients with these radiographic findings.
