Chondrosarcoma presenting with pulmonary embolism in a 9-year-old girl: a case report

Diagnostic transcatheter aspiration for pulmonary artery tumor embolism using an INARI Triever aspiration catheter

Pulmonary artery tumor embolism is a rare phenomenon and its diagnosis is important because of a poor prognosis. We report a 20-year-old male with history of metastatic osteosarcoma who presented with acute pulmonary embolism. He was urgently taken to the catheterization laboratory and underwent transcatheter aspiration of pulmonary artery mass using an INARI Triever aspiration catheter. Pathology of the aspirated specimen lead to the diagnosis of pulmonary artery tumor embolism, not thrombus. This case highlights the diagnostic utility of transcatheter aspiration for the pulmonary artery tumor embolism.

Occult Adrenocortical Carcinoma and Unexpected Early Childhood Death

A four-year-old previously well boy collapsed unexpectedly and was taken immediately to hospital, where he developed seizures and cardiogenic shock with lethal, rapidly progressing multi-organ failure. At autopsy, the height was >90th percentile and there were indications of early virilization. Internally, a friable tumor of the left adrenal gland was identified that had invaded the left renal vein and inferior vena cava. Histology revealed typical features of an adrenocortical carcinoma with aggregated trabeculae of cells containing abundant eosinophilic cytoplasm and large pleomorphic nuclei. There was strong positive cytoplasmic staining for inhibin; mitochondria were shown on electron microscopy to contain prominent electron-dense granules. Death was due to massive pulmonary tumor embolism. Although adrenocortical carcinomas are very rare and are more commonly found in adults, the current case demonstrates that they may also occur in childhood and be responsible for unexpected death by the very unusual mechanism of tumor embolism.