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K. Rajapaksha
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 2
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-035 - Surgical Perplexities in a Rare Case of Symptomatic Mediastinal Lymphangioma (ID 3990)
14:30 - 14:30 | Author(s): K. Rajapaksha
- Abstract
Background:
Mediastinal lymphangiomas are very rare and are often found in close proximity to vital structures of the head and neck. Thus, the surgical approach can be challenging. It is debatable to employ open surgery techniques via a trap-door incision or median-sternotomy in attempt to achieve complete surgical resection for a benign lesion. We report a case of symptomatic mediastinal lymphangioma that was successfully managed with a Video Assisted Thoracoscopic Surgery (VATS) approach.
Methods:
A 28-year-old female with no significant past medical history was found to have a superior mediastinal mass on a chest radiograph whilst undergoing investigations for acute left-sided upper back pain. Computed tomography (CT) study of the thorax revealed a large lobulated soft tissue mass in the left superior mediastinum, extending to the supraclavicular region, measuring approximately 4.4 x 4.9 x 7.4 cm, encasing the left carotid, subclavian and vertebral arteries, and the left internal jugular and brachiocephalic veins. Ultrasound guided core biopsy was inconclusive.
Results:
The patient underwent surgery via left VATS approach. Frozen section of the lesion revealed partial lymphoid infiltrates and scattered cystic-like spaces. No atypical cells or malignancy was seen. Maximal debulking of the lesion was performed with the aid of bipolar diathermy and harmonic ultrasonic energy devices instead of a complete resection. The patient made an uneventful recovery and was discharged home on the first post-operative day. Histological examination showed lymphoid aggregrates and dilated lymphatic spaces with a rim of smooth muscle that are typical of lymphangiomas. She remained well and pain free at her 1yr follow-up clinic.
Conclusion:
In conclusion, due to the unique nature and characteristics of mediastinal lymphangiomas, pre-operative diagnosis and treatment are challenging. Minimally invasive techniques for maximum debulking are useful for symptomatic treatment as complete resection may not always be possible.
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P2.04-038 - Primary Pulmonary Meningioma: Rare Tumour with Malignant Potential (ID 3916)
14:30 - 14:30 | Author(s): K. Rajapaksha
- Abstract
Background:
Primary Pulmonary Meningioma (PPM) is a very rare tumour with approximately 40 cases described in previous medical literature. Although majority of the cases documented previously are benign, there were 3 cases that showed malignant characteristics. We report a case of PPM with atypical features.
Methods:
A 65-year-old lady, non-smoker, had an incidental finding of 1.9 x 1.6cm nodule in the right middle lobe on routine chest x-ray. The computed tomography (CT) of the thorax demonstrated a well-defined, homogeneous soft tissu nodule measuring 1.5 x 1.5 cm in the lateral segment of the right middle lobe. CT-guided biopsy did not show features of malignancy. Hence, the patient was managed conservatively with surveillance CT scans. Four years later, repeat CT thorax revealed enlargement of the tumour size to 3.1 x 2.2 cm, with increased lobulations.
Results:
The patient underwent completely portal robotic middle lobectomy and mediastinal lymph node dissection. The patient made an uneventful recovery and was discharged on post-operative day 3. Histological examination revealed a 3.8 cm solid, circumscribed, whitish, homogeneous nodule that abuts the pleural surface. Microscopically, the tumour comprised of bland spindle cells arranged in fascicles and occasional whorls. The cells had round to ovoid nuclei and moderate amounts of eosinophilic fibrillary cytoplasm. Up to 7 mitotic figures per 10 high power fields were identified. Stromal hyalinization, ectatic blood vessels and focal necrosis were seen in some area. The tumour cells were diffusely positive for vimentin and S-100, focally positive for cytokeratin AE1/3, synaptophysin and EMA, and negative for chromogranin. Overall, histology of the specimen demonstrated characteristic patterns of meningiomas with atypical features. The lymph nodes sampled were negative for malignancy. There were no intra-cranial or spinal lesions. There was no tumour recurrence at the 1-yr follow-up.
Conclusion:
PPM is a rare tumour which requires timely surgical resection for diagnosis and treatment. Untreated benign behaving lesions have the potential to become aggressive and demonstrate atypical features.
