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J. Zhang
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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: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-050 - Giant Solitary Fibrous Tumor of the Pleura Saved by Biopsy and Following Extended Resection: A Long Term Surviving Case (ID 5326)
14:30 - 14:30 | Author(s): J. Zhang
- Abstract
Background:
Giant tumor almost occupied the entire one-side thoracic cavity could be surgically resected completely is rare. Solitary fibrous tumor of the pleura (SFTP) is less common, giant SFTP, which could be surgically resected completely, could survive long term, is rare. Here we report one case giant SFTP.
Methods:
A male aged 39 in Dec 2008, with chest distress, fatigue and low-grade fever for 2 weeks, chest pain and dyspnea for 1 week, no bleeding sputum; chest CT revealed a giant tumor almost occupied the entire left-side thoracic cavity, with pleural effusion. Bloody pleural fluid was drawn but no malignant tumor cells was confirmed. Malignant mesothelioma was diagnosed at local hospital, not operable, no effective chemotherapy or radiation available. The patient was referred to our Lung Cancer Center. Biopsy was first advised. Biopsy pathology: SFTP (malignant). Surgical resection should be of the best choice even though the young patient seemed to be too fatigue to endure the large-incision traditional standard posterolateral thoracotomy (TSPT, 30~40cm long chest incision, with the latissimus dorsi and serratus anterior muscles being cut, usually one rib being cut).
Results:
Posterolateral incision was about 40cm long, S shape, with one rib cut, but the surgery space was still too limited to explore the giant tumor, to separate the intrathoracic adhesion. Incision was extended, and another rib was cut to enlarge the surgical field. The tumor occupied the whole thoracic cavity, bottom originated from visceral pleura of left apicalposterior (S1+2) and superior (S6) segments. Tumor 22cm×15cm×7cm was completely separated and en bloc resected, with S1+2 and S6 segments wedge-resected (cutting edges at least 2cm far from tumor). Postoperative pathology: SFTP (malignant). The patient recovered surprisingly quickly, drainage tube pulled out at 5[th] day, he was discharged at the 8[th] day postoperatively. No adjuvant treatment was used. Follow-up shows no recurrence and metastasis. The patient is now alive healthily in his 8th year postoperatively,
Conclusion:
Giant SFTP is rare, easily to be misdiagnosed to malignant mesothelioma, losing opportunity of being cured. Biopsy is the key point to make a right diagnosis. Giant SFTP, benign or malignant, usually is operable; complete en bloc resection of the whole tumor and enough resection of originated visceral pleura and lung tissue is the key point to avoid recurrence, to cure SFTP. (This study was partly supported by Science Foundation of Shenyang City, China, No. F16-206-9-05).
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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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P3.04-041 - Giant Solitary Fibrous Tumor of the Pleura Saved by Biopsy and Following Extended Resection: A Long Term Surviving Case (ID 5270)
14:30 - 14:30 | Author(s): J. Zhang
- Abstract
Background:
Giant tumor almost occupied the entire one-side thoracic cavity could be surgically resected completely is rare. Solitary fibrous tumor of the pleura (SFTP) is less common, giant SFTP, which could be surgically resected completely, could survive long term, is rare. Here we report one case giant SFTP.
Methods:
A male aged 39 in Dec 2008, with chest distress, fatigue and low-grade fever for 2 weeks, chest pain and dyspnea for 1 week, no bleeding sputum; chest CT revealed a giant tumor almost occupied the entire left-side thoracic cavity, with pleural effusion. Bloody pleural fluid was drawn but no malignant tumor cells was confirmed. Malignant mesothelioma was diagnosed at local hospital, not operable, no effective chemotherapy or radiation available. The patient was referred to our Lung Cancer Center. Biopsy was first advised. Biopsy pathology: SFTP (malignant). Surgical resection should be of the best choice even though the young patient seemed to be too fatigue to endure the large-incision traditional standard posterolateral thoracotomy (TSPT, 30~40cm long chest incision, with the latissimus dorsi and serratus anterior muscles being cut, usually one rib being cut).
Results:
Posterolateral incision was about 40cm long, S shape, with one rib cut, but the surgery space was still too limited to explore the giant tumor, to separate the intrathoracic adhesion. Incision was extended, and another rib was cut to enlarge the surgical field. The tumor occupied the whole thoracic cavity, bottom originated from visceral pleura of left apicalposterior (S1+2) and superior (S6) segments. Tumor 22cm×15cm×7cm was completely separated and en bloc resected, with S1+2 and S6 segments wedge-resected (cutting edges at least 2cm far from tumor). Postoperative pathology: SFTP (malignant). The patient recovered surprisingly quickly, drainage tube pulled out at 5[th] day, he was discharged at the 8[th] day postoperatively. No adjuvant treatment was used. Follow-up shows no recurrence and metastasis. The patient is now alive healthily in his 8th year postoperatively,
Conclusion:
Giant SFTP is rare, easily to be misdiagnosed to malignant mesothelioma, losing opportunity of being cured. Biopsy is the key point to make a right diagnosis. Giant SFTP, benign or malignant, usually is operable; complete en bloc resection of the whole tumor and enough resection of originated visceral pleura and lung tissue is the key point to avoid recurrence, to cure SFTP. (This study was partly supported by Science Foundation of Shenyang City, China, No. F16-206-9-05).
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P3.04-043 - Minimally Invasive Small Incision, Muscle- and Rib-Sparing Thoracotomy (miMRST) for Multiple Sclerosing Pneumocytomas (ID 5268)
14:30 - 14:30 | Author(s): J. Zhang
- Abstract
Background:
Sclerosing pneumocytoma is less common, multiple sclerosing pneumocytomas are rare. Sclerosing pneumocytoma was called sclerosing hemangioma of the lung before WHO new classification of lung tumors was published in 2015. Here we report two cases, one was multiple sclerosing pneumocytomas, both received surgical resection via minimally invasive small incision, muscle- and rib-sparing thoracotomy (miMRST).
Methods:
Case 1: a female aged 60 in Aug 2012, chest CT was taken because of cough and fever 38.5℃, a 5cm tumor at right lower lobe, and a 0.8cm nodule at right middle lobe were found. The patient feared of the 30~40cm long “large-incision” of traditional standard posterolateral thoracotomy (TSPT), miMRST was scheduled. Case 2: a male aged 50 in Nov 2012, chest CT revealing an asymptomatic 2cm tumor at right upper lobe. The patient refused TSPT, preferred to accept miMRST.
Results:
About 10cm lateral chest incision was enough for lung lobectomy and mediastinal lymph node dissection, with the latissimus dorsi and serratus anterior muscles were protected, no rib cut needed. Case 1: right lower lobe lobectomy was performed first, frozen pathological diagnosis: inflammatory lesion with pneumocyte dysplasia, locally with hemangioma-like lesion. Wedge resection was performed to remove the nodule at right middle lobe. Postoperative pathology: both tumors were sclerosing hemangioma of the lung (Aug 2012). Case 2: enucleation was performed, frozen pathological diagnosis: sclerosing hemangioma of the lung, malignancy should be excluded by later paraffin slides staining. Right upper lobe lobectomy with mediastinal lymph node dissection was performed. Postoperative pathology: sclerosing hemangioma of the lung, no lymph node metastasis (Nov 2012). Both patients recovered much better and more quickly than other patients who underwent TSPT in the same ward at that time. Regular follow-up: both are alive healthily in their 4th year postoperatively, no recurrence and metastasis. No adjuvant treatment was used.
Conclusion:
Multiple sclerosing pneumocytomas are rare. For sclerosing pneumocytoma, surgical resection is of first choice. Limited resection should be enough and reasonable for this kind of benign tumor, however, lobectomy becomes essential once the tumor size is too big, further, mediastinal lymph node dissection is to be performed when malignancy is suspected. miMRST, is minimally invasive thoracic surgery, with no need to use expensive thoracoscopic devices, is very suitable for lung surgery in developing countries. (This study was partly supported by Science Foundation of Shenyang City, China, No. F16-206-9-05).
