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Zhang W, Li P, Yu J. Primary Pulmonary Artery Leiomyosarcoma with Pulmonary Metastasis Depicted on Enhanced Computer Tomography: A Case Description and an Analysis of the Literature. J Cardiovasc Dev Dis 2023; 11:1. [PMID: 38276654 PMCID: PMC10816034 DOI: 10.3390/jcdd11010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Pulmonary artery leiomyosarcoma is an extremely rare disease, with only a few dozen cases reported worldwide to date. This disease is easily misdiagnosed as pulmonary thromboembolism, leading to improper treatment and accurate diagnosis in the later stages of the disease. Furthermore, this delayed diagnosis may also be the reason for the extremely high mortality rate of patients suffering from it. Early invasive surgery with the goal of complete surgical resection is the standard treatment method. Chemotherapy and radiation therapy have been tried with variable outcomes.
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Affiliation(s)
- Wenzhao Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Alley, Chengdu 610041, China
| | - Peiling Li
- Department of Critical Care Medicine, Chengdu Shangjinnanfu Hospital, Chengdu 611730, China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Alley, Chengdu 610041, China
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2
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Rijal R, Mridha AR, Arava SK, Behera C. Primary intimal sarcoma of the pulmonary artery misdiagnosed as pulmonary thromboembolism: A case confirmed at medicolegal autopsy. J Forensic Sci 2020; 66:403-406. [PMID: 33031598 DOI: 10.1111/1556-4029.14592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54-year-old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.
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Affiliation(s)
- Reisha Rijal
- Department of Forensic Medicine & Toxicology, All India Institute of Medical sciences, New Delhi, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical sciences, New Delhi, India
| | - Sudheer Kumar Arava
- Department of Pathology, All India Institute of Medical sciences, New Delhi, India
| | - Chittaranjan Behera
- Department of Forensic Medicine & Toxicology, All India Institute of Medical sciences, New Delhi, India
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3
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Demirci NY, Naurzvai N, Kirbaş I, Akyürek N, Gürsel G, Öztürk C. Pulmonary artery leiomyosarcoma: A clinical dilemma. Lung India 2018; 35:164-167. [PMID: 29487255 PMCID: PMC5846269 DOI: 10.4103/lungindia.lungindia_137_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Leiomyosarcomas are rare neoplasms of the smooth muscles. Primary pulmonary leiomyosarcomas, which constitute approximately 0.2%–0.5% of all primary lung malignancies, are extremely rare and highly lethal. They may originate from the smooth muscle cells of the bronchial wall, the blood vessels, or the pulmonary interstitium, and their rare occurrence, localization, and nonspecific clinical symptoms mean that correct diagnosis and proper management are often delayed. Here, we report a rapidly growing primary pulmonary leiomyosarcoma, which invaded the right atrium, vena cava superior, mediastinum, right hilar area, and left pulmonary artery within 4 months. On histopathology, a transthoracic needle biopsy of the mass confirmed leiomyosarcoma, and delayed presentation meant that there was a local spread to the neighboring structures at the time of diagnosis.
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Affiliation(s)
| | - Nurgül Naurzvai
- Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ismail Kirbaş
- Department of Radiology, Lokman Hekim Hospital, Ankara, Turkey
| | - Nalan Akyürek
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gül Gürsel
- Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Can Öztürk
- Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey
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4
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Müller AV, Marschner CB, Kristensen AT, Wiinberg B, Sato AF, Rubio JMA, McEvoy FJ. Pulmonary vasculature in dogs assessed by three-dimensional fractal analysis and chemometrics. Vet Radiol Ultrasound 2017; 58:653-663. [DOI: 10.1111/vru.12536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/08/2017] [Accepted: 05/24/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anna V. Müller
- Department of Veterinary Clinical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - Clara B. Marschner
- Department of Veterinary Clinical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - Annemarie T. Kristensen
- Department of Veterinary Clinical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - Bo Wiinberg
- Haemophilia Biology, Global Research Unit; Novo Nordisk A/S; Maaloev Denmark
| | - Amy F. Sato
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton MA
| | - Jose M. A. Rubio
- Department of Food Science; University of Copenhagen; Frederiksberg C Denmark
| | - Fintan J. McEvoy
- Department of Veterinary Clinical Sciences; University of Copenhagen; Frederiksberg C Denmark
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5
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Hajsadeghi S, Kooranifar S, Ansarinejad N, Sadeghipour A, Iranpour A, Aziz Ahari A. Metastatic pulmonary artery sarcoma presented with tamponade: a case report. Clin Case Rep 2017; 5:1007-1010. [PMID: 28588856 PMCID: PMC5457986 DOI: 10.1002/ccr3.989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Abstract
Pulmonary artery sarcoma is a rare tumor with varying presentations including pericardial effusion and pulmonary metastasis. Single‐nucleotide polymorphism array is a novel method that can be used to define tumor genome and be used as a guidance to choose the proper treatment regimen.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Department of Cardiovascular Disease Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Siavash Kooranifar
- Department of Pulmonary and Critical Care Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Nafise Ansarinejad
- Department of Hematology and Oncology Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Alireza Sadeghipour
- Department of Pathology Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Aida Iranpour
- Department of Internal Medicine Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Alireza Aziz Ahari
- Department of Radiology Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
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6
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Abstract
A 59-year-old man presented cough, chest pain, and shortness of breath for 2 weeks and fever for 4 days. A contrast chest CT revealed a large right pulmonary artery filling defect, suggestive of pulmonary embolism that failed to respond to anticoagulation therapy. FDG PET/CT was performed to evaluate possible malignancy, which revealed intense activity in the right main pulmonary artery without any extrathoracic abnormality. The ratio of the SUVmax of this lesion to the liver was significantly increased in the delayed PET images. The pathological examination demonstrated primary pulmonary artery sarcoma.
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7
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Bandyopadhyay D, Panchabhai TS, Bajaj NS, Patil PD, Bunte MC. Primary pulmonary artery sarcoma: a close associate of pulmonary embolism-20-year observational analysis. J Thorac Dis 2016; 8:2592-2601. [PMID: 27747013 DOI: 10.21037/jtd.2016.08.89] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary pulmonary artery sarcoma (PPAS) is a rare tumor that mimics pulmonary thromboembolism (PE). Similarities to PE can delay the diagnosis and misguide the treatment of PPAS. This study aimed to evaluate tumor characteristics and outcome predictors among those diagnosed with PPAS and misdiagnosed as PE. METHODS From 1991-2010, 10 PPAS cases were available from the Cleveland Clinic (CC) institutional database and another 381 cases were reported in the literature. Patient characteristics, tumor subtypes, diagnostic testing & timing, interventions and clinical outcomes were analyzed. We also noted effects of misdiagnosis as PE and clinical outcome as a result of inappropriate intervention. RESULTS Among 391 confirmed cases of PPAS, the mean age at diagnosis was 52±14 years; 55% were male. The median duration of symptoms prior to diagnosis was 100 [interquartile range (IQR), 30-210] days. Nearly half (47%) of PPAS were originally misdiagnosed as PE including 39% that received thrombolytic and/or anticoagulation therapy. For every doubling of time from symptom onset to diagnosis, the odds of death increased by 46% (OR: 1.46, 95% CI: 1.21-1.82; P<0.001). The odds of death (OR: 2.66, 95% CI: 1.58-4.54; P=0.0003) and occurrence of distant metastasis (OR: 2.30, 95% CI: 1.30-4.15; P=0.049) were increased among those who did not receive chemotherapy but chemotherapy did not impact local recurrence. Those with complete resection had a better survival. CONCLUSIONS PPAS has a radiological appearance similar to PE, which makes accurate and timely diagnosis challenging. More rapid diagnosis may lead to earlier, appropriate surgical treatment and improved outcomes, when combined with adjuvant treatment.
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Affiliation(s)
| | | | | | - Pradnya D Patil
- Department of Internal medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew C Bunte
- Department of Cardiovascular Medicine, St Luke's Health System, Kansas, MO, USA
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8
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Muganlinskaya N, Guzman A, Dahagam C, Selinger SR. When a pulmonary embolism is not a pulmonary embolism: a rare case of primary pulmonary leiomyosarcoma. J Community Hosp Intern Med Perspect 2015; 5:29624. [PMID: 26653696 PMCID: PMC4677584 DOI: 10.3402/jchimp.v5.29624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/08/2015] [Accepted: 10/16/2015] [Indexed: 11/14/2022] Open
Abstract
Arterial leiomyosarcomas account for up to 21% of vascular leiomyosarcomas, with 56% of arterial leiomyosarcomas occurring in the pulmonary artery. While isolated cases of primary pulmonary artery leiomyosarcoma document survival up to 36 months after treatment, these uncommon, aggressive tumors are highly lethal, with 1-year survival estimated at 20% from the onset of symptoms. We discuss a rare case of a pulmonary artery leiomyosarcoma that was originally diagnosed as a pulmonary embolism (PE). A 72-year-old Caucasian female was initially diagnosed with 'saddle pulmonary embolism' based on computerized tomographic angiography of the chest 2 months prior to admission and placed on anticoagulation. Dyspnea escalated, and serial computed tomography scans showed cardiomegaly with pulmonary emboli involving the right and left main pulmonary arteries with extension into the right and left upper and lower lobe branches. An echocardiogram on admission showed severe pulmonary hypertension with a pulmonary artery pressure of 82.9 mm Hg, and a severely enlarged right ventricle. Respiratory distress and multiorgan failure developed and, unfortunately, the patient expired. Autopsy showed a lobulated, yellow mass throughout the main pulmonary arteries measuring 13 cm in diameter. The mass extended into the parenchyma of the right upper lobe. On microscopy, the mass was consistent with a high-grade primary pulmonary artery leiomyosarcoma. Median survival of patients with primary pulmonary artery leiomyosarcoma without surgery is one and a half months, and mortality is usually due to right-sided heart failure. Pulmonary artery leiomyosarcoma is a rare but highly lethal disease commonly mistaken for PE. Thus, we recommend clinicians to suspect this malignancy when anticoagulation fails to relieve initial symptoms. In conclusion, early detection and suspicion of pulmonary artery leiomyosarcoma should be considered in patients refractory to anticoagulation, prompting initiation of early intervention.
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Affiliation(s)
- Nargiz Muganlinskaya
- Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA;
| | | | - Chanukya Dahagam
- Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA
| | - Stephen R Selinger
- Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA
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9
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Ebner L, Huber A, Ott D, Christe A. Pulmonary intimal sarcoma: a rare differential diagnosis for arterial filling defects on a chest CT. Acta Radiol Short Rep 2014; 3:2047981613514052. [PMID: 24778802 PMCID: PMC4001433 DOI: 10.1177/2047981613514052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/02/2013] [Indexed: 11/16/2022] Open
Abstract
We present a rare case of pulmonary intimal sarcoma mimicking pulmonary embolism in a 40-year-old woman. Although extremely rare, these tumors must be considered in patients who present inappropriate imaging findings that suggest embolism. Chest computed tomography is the modality of choice to determine the extent of the tumor. We present a female patient with suspected embolism that was in fact found to be an endothelial sarcoma of the pulmonary arteries.
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Affiliation(s)
- Lukas Ebner
- Inselspital, University Hospital Bern, Departement for Diagnostic, Pediatric and Interventional Radiology, Bern, Switzerland
| | - Adrian Huber
- Inselspital, University Hospital Bern, Departement for Diagnostic, Pediatric and Interventional Radiology, Bern, Switzerland
| | - Daniel Ott
- Inselspital, University Hospital Bern, Departement for Diagnostic, Pediatric and Interventional Radiology, Bern, Switzerland
| | - Andreas Christe
- Inselspital, University Hospital Bern, Departement for Diagnostic, Pediatric and Interventional Radiology, Bern, Switzerland
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10
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Lee EJ, Moon SH, Choi JY, Lee KS, Choi YS, Choe YS, Lee KH, Kim BT. Usefulness of fluorodeoxyglucose positron emission tomography in malignancy of pulmonary artery mimicking pulmonary embolism. ANZ J Surg 2012; 83:342-7. [DOI: 10.1111/j.1445-2197.2012.06205.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Eun Jeong Lee
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Joon Young Choi
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Kyung Soo Lee
- Department of Radiology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Yearn Seong Choe
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
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11
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Dias OM, Lombardi EMS, Canzian M, Soares Júnior J, Vieira LDO, Terra Filho M. 18F-fluorodeoxyglucose positron emission tomography as a noninvasive method for the diagnosis of primary pulmonary artery sarcoma. J Bras Pneumol 2012; 37:817-22. [PMID: 22241041 DOI: 10.1590/s1806-37132011000600017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 09/02/2010] [Indexed: 11/21/2022] Open
Abstract
Pulmonary artery sarcomas are rare, difficult-to-diagnose tumors that frequently mimic chronic pulmonary thromboembolism. We report the cases of two female patients with clinical signs of dyspnea and lung masses associated with pulmonary artery filling defects on chest CT angiography. We performed 18F-fluorodeoxyglucose positron emission tomography, which revealed increased radiotracer uptake in those lesions. Pulmonary artery sarcoma was subsequently confirmed by anatomopathological examination. We emphasize the importance of this type of tomography as a noninvasive method for the diagnosis of these tumors.
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Affiliation(s)
- Olívia Meira Dias
- Department of Pulmonology, InCor/Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
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12
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Mittra ES, Iagaru AH, Leung AN. Case 166: Metastatic left pulmonary artery sarcoma. Radiology 2011; 258:645-8. [PMID: 21273527 DOI: 10.1148/radiol.10082169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Erik S Mittra
- Department of Radiology, Division of Nuclear Medicine, Stanford University Medical Center, 300 Pasteur Dr, Room H0101, Stanford, CA 94305,
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13
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Arévalo A, Da Cunha M, Piñón P, Bouzas B, Rivera S, Martínez V, Pombo J, Doval L. La importancia de un soplo tricuspídeo. Rev Clin Esp 2010; 210:e4-6. [DOI: 10.1016/j.rce.2009.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/19/2009] [Accepted: 11/27/2009] [Indexed: 11/30/2022]
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14
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Stella F, Davoli F, Brandolini J, Dolci G, Sellitri F, Bini A. Pulmonary artery leiomyosarcoma successfully treated by right pneumonectomy. Asian Cardiovasc Thorac Ann 2010; 17:513-5. [PMID: 19917796 DOI: 10.1177/0218492309348631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 79-year-old woman had a primary tumor of the pulmonary artery, which was initially diagnosed as chronic pulmonary thromboembolism. Multislice angio-computed tomography showed a solid mass in the right pulmonary artery. Radical resection of the tumor was achieved by right pneumonectomy via a transsternal transpericardial approach. The patient was alive and free of disease 36 months after surgery.
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Affiliation(s)
- Franco Stella
- Department of Thoracic Surgery, University of Bologna, S. Orsola-Malpighi, Hospital, Via Massarenti, 9, 40138 Bologna (BO), Italy
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15
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16
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17
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Kotelis D, Giesel F, Böckler D, Schumacher H, Schöbinger M, Allenberg JR. [Leiomyosarcoma of the inferior vena cava]. Chirurg 2007; 78:469-70, 472-3. [PMID: 17006706 DOI: 10.1007/s00104-006-1240-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Leiomyosarcomas of the inferior vena cava are rare and the clinical symptoms unspecific. We report a case of leiomyosarcoma of the inferior vena cava in an 82-year-old woman presenting with weight loss and abdominal pain. Following elaborate preoperative examinations, surgical resection was performed and the inferior vena cava was reconstructed. Clinical signs, diagnosis, therapy, and prognosis are discussed.
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Affiliation(s)
- D Kotelis
- Abteilung für Gefässchirurgie, Chirurgische Universitätsklinik, Ruprecht-Karls-Universität Heidelberg, 69120 Heidelberg, Deutschland.
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18
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Zidi A, Hantous-Zannad S, Jribi R, Ismail O, Belhabib D, Ben Miled-Mrad K. [Primitive leiomyosarcoma of the pulmonary artery]. JOURNAL DE RADIOLOGIE 2007; 88:75-7. [PMID: 17299372 DOI: 10.1016/s0221-0363(07)89794-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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19
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Maruo A, Okita Y, Okada K, Yamashita T, Tobe S, Tanimura N. Surgical Experience for the Pulmonary Artery Sarcoma. Ann Thorac Surg 2006; 82:2014-6. [PMID: 17126101 DOI: 10.1016/j.athoracsur.2006.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 06/29/2006] [Accepted: 07/12/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pulmonary sarcoma arising from the pulmonary artery is a rare disease and its prognosis is disastrous. METHODS Five patients who underwent surgery for pulmonary artery sarcoma were reviewed. RESULTS All patients except one were initially diagnosed with pulmonary embolism. One patient with preoperative profound shock could not wean from cardiopulmonary bypass. Two patients are still surviving for 36 and 30 months, respectively. CONCLUSIONS Early diagnosis and complete surgical resection is perhaps the best way to improve patients with pulmonary artery sarcoma.
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Affiliation(s)
- Ayako Maruo
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Hyogo, Japan.
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20
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Abstract
This review presents an imaging-centred approach to the diagnostic challenge of uncommon lung tumours in adults. Emphasis is placed on features that may be used to differentiate these tumours including fat content, tumour site, multifocality, calcification and predominant pattern of involvement.
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Affiliation(s)
- K Bhatia
- Department of Diagnostic Imaging, Royal London Hospital, Whitechapel, London, UK
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21
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Miura S, Meirmanov S, Nakashima M, Hayashi T, Abe K, Tamaru N, Miyahara Y, Sekine I. Intimal sarcoma of the pulmonary artery: Report of an autopsy case. Pathol Res Pract 2005; 201:469-74. [PMID: 16136754 DOI: 10.1016/j.prp.2005.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary pulmonary artery sarcomas (PASs) are rare and lethal tumors. They are easily misdiagnosed as chronic pulmonary embolism, mediastinal mass or tumor emboli, which delay a proper treatment. Although the advanced technologies are now increasingly being used, their diagnosis is usually hard to establish preoperatively at the present time. We report here a case of a 68-year-old female with PAS with lung metastases, who firstly presented with symptoms of common cold and anemia. Although a PAS had been suspected, the final diagnosis of pulmonary intimal sarcoma was made only postoperatively by histological and immunohistochemical examination. The patient died 8 months after the operation because of tumor growth progression, despite adjuvant chemotherapy and radiation therapy. Although pulmonary intimal sarcomas are usually of poorly differentiated mesenchymal malignancy, most reported cases are immunohistochemically positive for vimentin, alpha-smooth muscle actin (SMA), and/or desmin, therefore resembling leiomyosarcomas. However, the diagnosis of leiomyosarcoma should not be made on the basis of immunostains in the absence of typical morphologic features, and PAS, like the present case, should be more appropriately classified as intimal sarcoma according to the new WHO Classification of Tumours of Soft Tissue and Bone published in 2002.
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Affiliation(s)
- Shiro Miura
- Department of Molecular Pathology, Division of Scientific Data Registry, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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22
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Allen S, Todd J, Copley S, Al-Nahhas A. F-18 FDG Uptake in Bilateral Pulmonary Artery Leiomyosarcomata, One Mimicking a Pulmonary Embolus. Clin Nucl Med 2005; 30:418-9. [PMID: 15891297 DOI: 10.1097/01.rlu.0000162964.84907.3f] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Steven Allen
- Department of Nuclear Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
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Abstract
Diagnostic imaging has played a major role in the evaluation of patients with cancers of the bone and soft tissue. The imaging modalities have included radiography, computed tomography, magnetic resonance imaging, and bone scintigraphy. Current experience suggests that functional imaging with positron emission tomography (PET) and [F-18]fluorodeoxyglucose (FDG) may also have an important role in the imaging evaluation of patients with bone and soft tissue sarcoma, including guiding biopsy, detecting local recurrence in amputation stumps, detecting metastatic disease, predicting and monitoring response to therapy, and assessing for prognosis. Prospective studies with large patient groups will be essential to define the exact diagnostic role of FDG PET in this clinical setting, which should also include an evaluation of the cost-effectiveness and the short-term and long-term benefits in clinical decision making and management. In this article, we review the diagnostic utility of dedicated PET and PET combined with computed tomography imaging system in the evaluation of patients with bone and soft tissue malignancies.
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Affiliation(s)
- Hossein Jadvar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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