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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-002 - Contralateral Axillary Lymph Node Metastasis of a Lung Cancer: A Case Report (ID 5382)
14:30 - 14:30 | Author(s): T. Okay
- Abstract
Background:
Primary lung cancer metastasis to axillary lymph node is rare. Routine examination of the axilla is useful way to detect suspicious nodes.
Methods:
We evaluated retrospectively medical and pathological records of a male patient at our division who had a primary lung cancer with M1b axillary lymph node metastasis.
Results:
A 66-year-old male presented with shortness of breath. His chest x-ray showed a large opacity in the lower one-half of the right lung field. Computed tomography (CT) imaging revealed a solid mass in the right hemithorax measuring 50x50 mm. Positron emission tomography/Computed tomography (PET/CT) demonstrated increased fluorodeoxygucose uptake (Standard uptake value: 9,9) by the mass. Fiberoptic bronchoscopy was performed and transbronchial biopsy was consistent with squamous cell carcinoma. Mediastinoscopy was performed to evaluate the stage of the tumor and biopsies from 2R, 2L, 4R, 4L, 7. mediastinal lymph nodes had negative results. Right lower lobectomy was planned and due to invasion of the right middle lob vein and bronchus, right lower bilobectomy and mediastinal lymph node dissection were performed. Pathological evaluation of the tumor and lymph nodes showed that staging of the tumor was T2b N1 (11. lymph node had metastasis, although 2,4,7,9. lymph nodes were metastasis free). Patient was discharged on post-operative 7. days and received chemotherapy 12 cycles. During follow-up PET/CT revealed increased FDG uptake by mass in the residual right lung(SUV:9.3) and axillary subcentimetric nodule(SUV:11.1). Physical examination of the patient revealed a palpable nodule in the right axilla. Ultrasound guided needle biopsy was performed to this nodule but it had negative result. Before performing pulmonary resection, we decided to dissect this lymph node. 30 months after right lower bilobectomy, axillary lymph node dissection was performed and frozen section procedure demonstrated squamous cell lung carcinoma metastasis to axillary lymph node. Pulmonary resection was cancelled and patient was discharged post operatively 3.day and received chemotherapy again. After 6 month follow-up the patient was dead.
Conclusion:
Routine physical examination of axilla is recommended even if mediastinal lymph nodes are metastasis free either at initial presentation or at follow-up of patients. In this case metastatic axillary lymph node was subcentimetric, although according to Austin et al. 14 mm or larger axillary lymph nodes are suggestive of adenopathy. Fishman et al. considered 15mm or larger single axillary lymph node without fatty center as abnormal. Without mediastinal lymph nodes metastasis, contralateral axillary lymph node metastasis could be of systemic origin.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-039 - Solitary Fibrous Tumor of the Pleura Associated with Gynecomastia: A Case Report (ID 5771)
14:30 - 14:30 | Author(s): T. Okay
- Abstract
Background:
Fibrous tumor originated from pleura is a rarely seen lung tumor. It can be malignant or benign, and may cause paraneoplastic syndromes.
Methods:
In this study, we retrospectively evaluated a case in which a lung mass was detected during examination of the gynecomastia and operated in our hospital with the diagnosis of solitary fibrous tumor of the pleura.
Results:
53-year-old male patient was admitted to our clinic with the complaint of bilateral painful breast enlargement. Symmetrical gynecomastia with benign findings was detected in Category 2 level according to Breast Imaging-Reporting and Data System (BI-RADS) classification in the bilateral breast ultrasonography investigations. Thorax computed tomography imagination showed extrapleurally located mass lesion with solid character and 75x25mm in size. Mesothelial cells were observed in the material received by the computed tomography-guided needle biopsy. Thereupon, a decision was made to take the patient to the operation. Frozen section procedure was performed on the specimen received by video-assisted thoracic surgery (VATS) biopsy. Diagnosis could not be achieved therefore it was decided to perform resection by mini-thoracotomy due to the size and rigid structure of the mass. During the process, it was observed that fibrous mass was holding on to the right middle lobe with a pedicle and it was found to be free in the other regions. The entire mass was removed with the resection including the surrounding healthy parenchymal tissue and the operation was terminated. The patient was discharged on the postoperative day 3. In the pathological examination, a solitary fibrous tumor associated with visceral pleura in the dimensions of 85x55x27 mm was reported with the features of low mitotic activity, and focal hypercellularity, and showing strong positive staining for CD34, CD99 and Bcl-2. In the additional investigations in gynecomastia clinics, it was observed that tumor cells were stained at 67-70% with progesterone and 35-40% with estrogen. Staining with β-Hcg was not observed.
Conclusion:
Solitary fibrous tumors of pleura is rare. These tumors originate from mesenchymal cells, not from mesothelial cells. These solitary fibrous tumors may be malignant or benign. These tumors may be asymptomatic, may cause symptoms of pressure or may lead to paraneoplastic syndromes. Recurrence can happen. Appropriate surgical intervention should be selected.
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P3.04-040 - A Rare Case of Intrathoracic Mass: Intrathoracic Desmoid Tumor (ID 5762)
14:30 - 14:30 | Author(s): T. Okay
- Abstract
Background:
Desmoid tumor is a rare type of tumor which originates from abdominal fascial and musculo-aponeurotic structure. It generally occurs in the abdomen, but rarely may be derived from the chest wall. Pain is the main complaint of the patients admitted to hospital.
Methods:
In this study, we retrospectively evaluated the pre-surgical diagnostic methods, surgical intervention and post-operative follow-up processes and outcomes of a patient who admitted to hospital with a complaint of back pain and were operated in our hospital with the diagnosis of desmoid tumor.
Results:
57-year-old male patient was admitted to our clinic with tha complaints of left arm and back pain suffered approximately more than 1 year. Due to the increasing pain and ptosis in the left eye, imaging studies were performed and a mass was detected in the left hemithorax. Needle biopsy was applied to the patient two times but no results were obtained. Whereupon, the patient was referred to our clinic. During the physical examination of the patient in our clinic, a mild ptosis in his left eye, palpable and hard fixed mass in the left supraclavicular fossa and loss of breath sounds in the upper left side of the hemithorax were detected. Thorax computed tomography imagination showed an extrapleural mass, 17x13x12 cm in size, which fills the superior and posterior mediastinum with the plexus. Additionally, a mass, 154x114x114 mm in size was reported with SUV upper value of 4.85, consisting with malignancy in the PET-computed tomography. Upon this, posterolateral thoracotomy surgery was applied to the patient and the mass was removed en bloc. The mass was reported as a desmoid tumor based on the pathological findings and the patient was discharged on the postoperative day 6. In the 3rd month of follow-up process, 54 Gy / 30 fr radiotherapy was applied to the left hemitorax apical tumor location. In the control imaging studies following 3., 8., 24. and 30. months of the surgery, no lesion compatible with the recurrence was detected.
Conclusion:
Desmoid tumor is a rare type of tumor originating from abdominal fascial and musculo-aponeurotic structure. Surgical resection is needed. Because of the possibility of recurrence, surgical intervention should be modified in a way to remain the quality of patient's life.
