Author of

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 3
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P1.24-014 - Metastatic angiosarcoma presenting as haemoptysis and severe pain on the back (ID 1172)

    09:30 - 09:30  |  Author(s): F. Alkan
    • Abstract

    Background
    Angiosarcoma is a rare malignant neoplasm of the vascular or lymphatic endothelium that accounts for 2% of all soft-tissue sarcomas.Angiosarcoma in the lung is a rare disorder and is usually attributable to metastasis from primary site such as skin, soft-tissue, heart, breast or liver.We describe a case of pulmonary metastatic angiosarcoma who presented with episodic haemoptysis and severe pain on the back.

    Methods
    A 21-year-old male was admitted with history of recurrent hemoptysis and pain on the his back for two months.There were no other constitutional symtoms.Thoracic and abdominal computed tomograhy scan revealed left hilar lymphadenopathy and bilateral multiple nodules; the spleen was enlarged and shown multipl hypodense lesions.Hilar lymphadenopathy was sampled by real time convex prob EBUS TBNA and CT guided transthoracic fine needle aspiration was performed.Definitive diagnosis couldnt be obtained with both procedures.PET scan revealed the widespread FDG uptake bone marrow, liver and spleen and lung. The patients underwent bone marrow biopsy and histopathological examination of yields reported angiosarcoma.Immunohistochemistry (CD 31 positivity) confirmed the diagnosis of angiosarcoma.

    Results
    The patient showed progressive deterioration and anemia and thrombositopenia and hemoperitoneum owing to spontaneous liver rupture appeared.He was managed with repeated blood transfusions but he died twenty-seventh days after admitted hospital.

    Conclusion
    We presented a rare angiosarcoma case with aggressive clinical course and a fatal prognosis for the patient.

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    P1.24-033 - A rare case: lung cancer and multiple myeloma (ID 2407)

    09:30 - 09:30  |  Author(s): F. Alkan
    • Abstract

    Background
    A multiple myeloma (MM) is a malignant disease of plasma cells, which manifests as one or more of lytic bone lesions, monoclonal protein in the blood and/or urine and disease in the bone marrow. The most typical thoracic manifestation of multiple myeloma is bony involvement of the thoracic cage. Other manifestations include pneumonia, intra-parenchymal mass lesions, mediastinal lymphadenopathy, interstitial pattern like reticulonodular shadows and intrapulmonary calcification. The diagnosis of a secondary solid neoplasm in patients with MM is uncommon, and it is debatable whether the MM itself is a risk factor for the incidence of a secondary solid neoplasm.

    Methods
    62 year-old men, former heavy smoker ,treated pulmonary tuberculosis(1977), autologous bone marrow transplantation (BMT) for MM two years ago.He admitted complaints of fever, cough,sputum and nigth sweats for a month. Physical examination was remarkable moderate pallor. Routıne serum biochemistry parameters were within normal limits except hemoglobin (6.6 gm/dl),ESR was 84 mm in the first hour.Chest xray and computed tomography (CT )showed multiple, bilateral,various size, well-circumscribed pulmonary nodules, containing calcification solid nodul 2 cm in diameter and periferal consolidatıon ın the rigth upper lob . Previous chest radiographs and CT had revealed the presence bilateral multiple nodules and low uptake18F‑fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) ( suv max:2.4).

    Results
    The patient underwent wedge resectıon rigth upper lobe for evaluating nodules three years ago.Histological examination demonstared weak -granulom formation and nodüles consisting dystrophic calcification ,multifocal hyalinisation and ossification It was considered sequelae of tuberculosis. Follow –up imaging studies increased in size,the number of pulmonary nodules and newly rigth 8th and left 6th rib hypermetabolik uptake in PET.CT -guided transthoracic needle aspiratıon biopsy performed the increasing nodul in the rigth upper lobe diagnosed adenocarcinoma.The patient is still alive and on follow-up.

    Conclusion
    Studies have shown that people who have had allogeneic transplants have a higher risk of second cancer than people who got a different type of stem cell transplant. In this case it is difficult to conclude whether TB sequelae caused lung cancer or the lung cancer simply associated in a patient with previously known pulmonary TB. Initial diagnosis of tuberculosis in such patients often misleads the physician to abandon further work-up resulting in overlooking or delayed diagnosis of the lung neoplasm,thus affecting their outcome

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    P1.24-034 - Cystic and cavitary appearance:an usual form of pulmonary metastasis of primer lung adenocarcinoma (ID 3040)

    09:30 - 09:30  |  Author(s): F. Alkan
    • Abstract

    Background
    Cystic and cavitary pulmonary lesions are abnormalities encountered on chest radiography and computed tomography (CT).Malignant lesions, including metastases, rarely present as cystic and cavitary lesions.Due to rarity such cases ,we report here a case of unusual form of pulmonary metastasis of primer lung adenocarcinoma

    Methods
    A 82-year old female patient admitted to hospital with complaints of dry cough,progressive dsypnea for a month .Her past history was unremarkable. Physical exam was normal.Chest X-ray revealed bilateral diffuse multpil cavitary and cystic lesions In routine laboratory tests, all were normal excepting Hb:10.7 g/dl, CRP:43 The thorax CT showed bilateral diffuse cysticand cavitary lesions in 1-3 cm diameter, with no thoracic lymphadenopathy . As the multiple lung nodules were suspected to be metastatic, 18F‑fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was conducted, which revealed that the nodules had mild uptake of 18F‑FCG ,a metabolic behaviour consistent with bening aetiologies diseases according to the nuclear medicine report.

    Results
    Bronchoscopy with bronchial lavage was performed. Cytology was negative for malignancy. Repeat CT scan of chest showed increase in size of lung lesions and new right-sided pleural effusion .CT-guide transthoracic needle aspiratıon biopsy was performed. The pathological examination revealed a metastasis of adenocarcinoma ,however histological differentiation of primary pulmonary adenocarcinoma from metastatic adenocarcinoma is sometimes difficult because of their phenotypic similarities So immunohistochemistry (IHC) was performed, the IHC of lung tumor: cytokeratin 20 (CK20)(-), cytokeratin7(CK7)(+), thyroid transcription factor(TTF)(-)Because of PET CT was no showed extrathoracic uptake,It was considered primary lung adenocarcinoma for final diagnosis.

    Conclusion
    One of the most important differences in the differential diagnosis of cystic or cavitary lung lesions is the distinction between malignant and benign aetiologies. Primary lung cancer is a common disease, cavitation being detected by CT for up to 22% of primary lung cancers but for near 11% by plain thoracic radiography. However pulmonary metastases can rarely cavitate, with a reported incidence less than 4% on chest radiographs [2]. Even cavitary lung metastases are rare and benign differential diagnosis are more common, clinician should be careful in neoplastic context and investigation should be done In rarity such cases ,we report here a case of unusual form of pulmonary metastasis of primer lung adenocarcinoma