Pulmonary artery sarcoma and severe valvular diseases in late-septuagenarian women: was 2-stage surgery an appropriate strategy? A case report

BACKGROUND

Pulmonary artery sarcomas (PASs) are rare, and complete tumor resection is often difficult at the time of detection. We encountered a case of PAS that was thought to be resectable; however, the patient had severe symptomatic valvular disease. We faced a difficult decision regarding the surgical strategy.

CASE PRESENTATION

A 76-year-old female presented with a history of polysurgery for multiple primary cancers. She was referred to our department with a calcified mass in the right pulmonary artery (PA) and severe symptomatic valvular disease. After a discussion with the cardiovascular surgeon, we decided to perform a two-stage surgery. She underwent valvuloplasty through a median sternotomy, resulting in an improvement in her exertional dyspnea. The tumor was removed three months later with a right upper lobectomy and PA patch reconstruction through a posterolateral thoracotomy. When the PA was opened, the edge of the tumor was entrapped by vascular clamp forceps because of insufficient dissection of the adhesions between the superior vena cava and the right main PA resulting from the first operation. The patient underwent proton therapy twice for chest wall metastases which recurred three months after surgery, and local recurrence in the PA was diagnosed five months after surgery. The patient was alive with stable disease 25 months after surgery.

CONCLUSION

Two-stage surgery for PAS and valvular disease resulted in incomplete resection of the PAS in the right PA. It is important not to underestimate surgical adhesions due to the initial surgery and to consider and implement measures to prevent adhesions of critical vessels during the second operation.

A primary pulmonary artery sarcoma masquerading pulmonary embolism: a case report and literature review

BACKGROUND

Primary pulmonary artery sarcoma (PAS) is an extremely rare malignant tumor with a poor prognosis. The clinical manifestations of PAS are diverse, including dyspnea, chest pain, cough, and hemoptysis. The poor prognosis is often due to delayed diagnosis caused by similarity in imaging findings with pulmonary thromboembolism (PTE). These cues of diagnosis include the "wall eclipsing sign", lobulated bulging margins, gadolinium enhancement during MRI imaging, and FDG uptake during PET/CT imaging. However, there are still many misdiagnoses.

CASE PRESENTATION

This article reports a woman of reproductive age presenting with a pulmonary artery mass. The computed tomographic pulmonary angiography and positron emission tomography/computed tomography did not show obvious signs of pulmonary artery sarcoma, however, contrast-enhanced echocardiography showed moderate perfusion, which helped differentiate between pulmonary artery sarcoma and pulmonary artery thrombosis, leading to timely surgical treatment.

CONCLUSIONS

PAS is a rare form of cancer that can occasionally be visually similar to PTE on radiographic images. Early diagnosis of PAS is of vital importance to the prognosis of the patients. There are several visual cues that can help differentiate between the two conditions. Additionally, contrast-enhanced echocardiography provides additional information on tumor perfusion, offering another effective approach for a prompt and accurate diagnosis.

Pulmonary artery sarcoma: an unexpected settler in the right ventricular outflow tract

Pulmonary artery sarcoma (PAS) is a sporadic malignant tumor that mainly originates from the pulmonary arteries. However, PAS may also involve the right ventricular outflow tract (RVOT) and lead to obstruction, syncope, or sudden death. Early diagnosis and complete surgical resection are essential to prolong survival and improve the quality of life of patients with PAS. Herein, we report a case of a young female patient admitted for pulmonary malignancy and acute pulmonary embolism. The patient had a mass in the RVOT, which was detected by transthoracic echocardiography. Computed tomography and magnetic resonance imaging revealed the invasion depth and extent of the lesions. Surgical resection improved hemodynamics, while pathological and immunohistochemical tests confirmed the diagnosis of a pulmonary artery sarcoma. Local recurrence was detected in the adjacent tissues about two months after the surgery. Given the potential risk of reoperation, the patient was suggested to undergo conservative treatment.

A case report of pulmonary artery intimal sarcoma negative for 18F-FDG mimicking pulmonary thromboembolism

Background

Pulmonary artery sarcoma is a rare malignant neoplasm arising from intimal mesenchymal cells in the pulmonary artery wall and is often difficult to differentiate from pulmonary embolism, however, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can be useful for a differential diagnosis. Here, we present a rare case of pulmonary sarcoma undetectable by PET.

Case summary

A 77-year-old woman who had worsening dyspnoea on effort for a month and progressive chest discomfort with nocturnal cough for a week presented to our hospital. Contrast-enhanced computed tomography (CT) demonstrated a massive filling defect in the left pulmonary artery (PA). Two major differential diagnoses were considered; pulmonary thromboembolism and tumour-like lesions. Positron emission tomography-computed tomography (PET-CT) revealed that there was no abnormal accumulation of 18F-FDG in the mass. However, even after effective anti-thrombotic treatment for 3 weeks, a follow-up CT showed no reduction at all in the size of the lesion in the pulmonary artery. Therefore, surgery for diagnostic therapeutic purposes was performed.

Discussion

The present case is informative because it supports the idea that being aware of PA angiosarcoma as a potential differential diagnosis of pulmonary thromboembolism is essential, particularly in cases of no evident peripheral venous thrombosis and a negative D-dimer test, even if neither heterogenous contrast enhancement in CT and magnetic resonance imaging nor accumulation of 18-FDG in PET-CT is evident.

Pulmonary artery sarcoma misdiagnosed as a pulmonary embolism: A case report

Pulmonary artery sarcoma is a rare type of tumor and is easily misdiagnosed. We report a case of pulmonary artery sarcoma in a 26-year-old young man who presented with acute onset of dyspnea. Computed tomographic angiography of the chest had revealed a large filling defect within the main pulmonary artery (PA) that extended into both right and left PAs. Because pulmonary embolism was suspected, both anticoagulant and thrombolytic therapies were initiated. The patient responded poorly to these therapies, leading to the resection of the mass. After an uneventful postoperative course, the patient was discharged from the hospital on postoperative day ten. He was subsequently treated with chemotherapy and continued to show no evidence of disease. Multimodal therapy can provide prolonged survival.

Multimodal treatment and imaging of primary pulmonary artery sarcoma: a case report

Primary pulmonary artery sarcoma (PAS) is a malignant neoplasm of the pulmonary vascular system originating from the intima, with clinical and imaging manifestations similar to those of pulmonary thromboembolism (PTE), and is often misdiagnosed. Spectral CT and PET/CT can clearly show the extent and metastasis of PAS and are valuable in visualizing adjacent structures such as lungs, bronchi, and mediastinum, providing a strong imaging basis for the diagnosis and differentiation of PAS, allowing treatment monitoring and follow-up.

Dual-Energy CT for Pulmonary Embolism: Current and Evolving Clinical Applications

Pulmonary embolism (PE) is a potentially fatal disease if the diagnosis or treatment is delayed. Currently, multidetector computed tomography (MDCT) is considered the standard imaging method for diagnosing PE. Dual-energy CT (DECT) has the advantages of MDCT and can provide functional information for patients with PE. The aim of this review is to present the potential clinical applications of DECT in PE, focusing on the diagnosis and risk stratification of PE.

Clinical Features and Outcomes of Pulmonary Artery Sarcoma

OBJECTIVES

A retrospective cohort study was designed to describe the clinical features and outcomes of pulmonary artery sarcoma (PAS).

METHODS

Twenty-two (22) consecutive patients diagnosed with PAS by pathological examination were enrolled and followed up until they died or until January 2020. The medical records were retrospectively reviewed to evaluate the clinical characteristics, image findings, and outcomes.

RESULTS

1) Twenty-one (21, 95.5%) patients were firstly misdiagnosed. Dyspnoea was the most common presenting symptom (19 of 22, 86.4%). 2) Filling defects in the right pulmonary artery were seen in 17 patients (77.3%) with computed tomography pulmonary angiography or magnetic resonance pulmonary angiography. Among those patients, 14 underwent positron emission tomography-computed tomography detection and 13 (92.9%) were found to have increased uptake value in the pulmonary artery. 3) The median survival (from diagnosis to death or January 2020) of the total series was 11.6 months (range, 0.7-68.5 months). The estimated cumulative survival rates at 1, 2, and 3 years were 52.6%, 32.8%, and 19.7%, respectively. Patients who received surgery and/or chemo-radiotherapy treatment had a better survival rate compared with patients without treatment (the estimated cumulative survival rates at 1, 2, and 3 years were 60.3%, 39.1%, and 29.3%, respectively, vs 33.3%, 16.6%, and 0, accordingly) and better survival time (median survival 17.02 vs 3.16 months, respectively) (p=0.025).

CONCLUSIONS

Pulmonary artery sarcoma is easily misdiagnosed, as the symptoms and routine image detection are nonspecific. Positron emission tomography-computed tomography may be helpful in diagnosis. Surgery and/or chemo-radiotherapy offer a chance for better outcomes.

A new-onset pulmonary artery stenosis in a young man: case report

Background 

Poorly differentiated and undifferentiated sarcomas are the most common primary tumours of the pulmonary arteries. They usually affect large-calibre vessels and present with predominantly intraluminal growth. Dyspnoea, cough, chest pain, and haemoptysis are the most common presenting symptoms. Clinical and imaging manifestations can mimic pulmonary embolisms and correct diagnosis may require multimodal imaging. The overall prognosis is poor; however, early diagnosis and complete surgical resection seem to improve the prognosis.

Case summary 

A 31-year-old male was admitted to our department after a pre-syncopal episode associated with dyspnoea of recent onset. Echocardiography showed a mass with irregular borders attached to the pulmonary artery trunk, almost obliterating its lumen and determining a flow acceleration with a peak velocity and gradient, respectively, of 3.8 m/s and 60 mmHg. At cardiac magnetic resonance imaging and positron emission tomography-computed tomography scan, the mass had inhomogeneous contrast impregnation and an intense 18-fluorodeoxyglucose uptake, both findings are highly suggestive of an angiosarcoma of the pulmonary artery. Biopsy specimens were taken through bronchoscopy but the material was insufficient for diagnosis. The patient decided to continue treatment in another hospital, where he died a few months later.

Discussion 

The presence of a unique mass involving the main trunk of the pulmonary artery or proximal branches associated with rapidly progressive dyspnoea in a patient at low risk for pulmonary embolism should raise the suspicion of primary sarcoma of the pulmonary artery. There are no guidelines for the treatment. Surgery and neo/adjuvant chemotherapy are reported in literature but burdened by bias and concerning a small number of cases.

Pulmonary artery fungal infection with imaging findings resembling pulmonary artery sarcoma

A 67-year-old female patient was admitted due to "coughing and chest tightness" for more than 7 months. She had recurring chest tightness and shortness of breath after activities for more than 3 months, which worsened in the past 1 month. More than 7 months ago, the patient had a severe cough with a small amount of white sputum and chest tightness and discomfort, and visited a local hospital. The heart color Doppler ultrasound and other examinations were checked, and she was diagnosed with pulmonary embolism. Pulmonary artery CTA (CT angiography) showed the shadow of an intraluminal filling defect in the proximal main pulmonary artery. Therefore, a diagnosis of pulmonary embolism was made, with proximal tortuous stenosis of the left main pulmonary artery and distal expansion, which were considered to be congenital malformations.

Primary pulmonary artery sarcoma with intrapulmonary metastases based on PET/CT imaging: a case report and literature review

Primary pulmonary artery sarcoma is an extremely rare and highly aggressive malignant tumor of cardiovascular system. It is usually misdiagnosed as pulmonary thromboembolism due to its atypical clinical features and similar clinical symptoms. Different from published reports, our case received both enhanced CT and 18F-FDG PET/CT examination before the pathologic result, and lung metastases had already occurred at the time of diagnosis. We herein reported a case of 41-year-old female patient who suffered from cough and chest tightness for more than a month. Laboratory examination indicated that both blood routine and tumor markers were within the normal range, and only the D-dimer slightly elevated. Contrast-enhanced chest computed tomography showed right pulmonary artery lesion and multiple nodular located right upper lung, the lesion was mild heterogeneous enhancement. No obvious abnormalities were found in deep vein of bilateral lower extremities on ultrasonography. In order to confirm the nature of these lesions, PET/CT scan was performed, which revealed stripe hypermetabolism in right pulmonary artery and nodular hypermetabolism in right upper lung, and the rest of the whole-body PET imaging were negative, a diagnosis of primary pulmonary artery malignancy with pulmonary metastases was made, and pulmonary thromboembolism was ruled out. Biopsy of right pulmonary lesions was performed and histopathological examination indicated pulmonary artery sarcoma. She only received palliative conservative medical treatment because the disease was late stage according to the tumor-node-metastasis (TNM) staging system, and did not acceptable surgical treatment, and was in good health during recent follow-up. Our study suggested that 18F-FDG PET/CT image is a good approach for the diagnosis of pulmonary artery sarcoma and could provide adjunct value for further treatment.

Surgical treatment of primary pulmonary artery sarcoma

OBJECTIVE

Primary pulmonary artery sarcoma (PAS) is a rare tumor that originates from the intimal layer of the pulmonary artery or pulmonary valve and has a poor prognosis. The standard treatment for this devastating disease remains unclear. This study aimed to summarize the current standard treatments for PAS.

METHODS

From September 2015 to January 2020, six patients were diagnosed with PAS and underwent pulmonary endarterectomy (PEA) at our department. Their medical records were retrospectively reviewed to analyze the clinical characteristics, histopathological features, and postoperative outcomes. Fourteen articles, each reporting at least 6 cases, identified 201 patients diagnosed with PAS, and 158 patients had detailed treatments and follow-up data.

RESULTS

All of the patients who successfully underwent PEA were alive at follow-up, with a mean survival duration of 11.6 months (7-28 months), and one patient developed recurrence in the right upper lobe lung. Two patients received postoperative chemotherapy. In one patient, the tumor invaded the pulmonary valve.

CONCLUSIONS

PAS resection combined with PEA via the aid of cardiopulmonary bypass and deep hypothermic circulatory arrest could achieve maximal tumor resection in patients without metastatic lesions. An individualized surgery strategy relies on a precise preoperative imaging examination. Moreover, postoperative adjuvant therapy could yield improved survival outcomes.

An unusual presentation of pulmonary artery sarcoma: Several pseudoaneurysms with massive hemoptysis

A 53-year-old woman was admitted to the emergency department with sudden onset of massive hemoptysis. She had previous history of dyspnea and cough for two months. She had no history of chronic disease, smoking, or use of anticoagulant and antiplatelet drugs. On arrival, she was tachycardic and tachypneic, but her body temperature was normal. Chest X-ray showed enlarged right hilus and multiple nodular opacities predominantly in the left lung basis. Computed tomography (CT) scan of the chest demonstrated massive intraluminal filling defect extending from the right pulmonary artery through the main and left pulmonary arteries. Pulmonary artery sarcoma (PAS) was the preliminary imaging-based diagnosis. However, CT also revealed presence of several pseudoaneurysms arising from the distal branches of the left pulmonary artery encased by metastatic nodules. Although hemoptysis is an uncommon presentation for patients with PAS, accompanied pseudoaneurysms were the main reason for massive hemoptysis. Differentiation of PAS from bland thromboembolism could be challenging on CT. Herein reported case provides an additional imaging feature that may utilize differentiating pulmonary artery sarcoma from bland thrombus.

Clues to diagnosis

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PPAS is an aggressive malignant tumor that masquerades as PE leading to a delay in diagnosis.

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Limited data exist on the clinical presentation, diagnosis, and management of PPAS.

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Knowledge of the clinical and imaging characteristics of this tumor is of importance for clinicians and surgeons.

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Early definitive surgery may improve survival; early diagnosis aided by imaging studies improves surgical outcomes.

Introduction

Primary pulmonary artery sarcoma (PPAS) is a very rare tumor that mimics pulmonary embolism (PE) in clinical presentation and on imaging studies, therefore leading to diagnostic delay and increased patient mortality.

Presentation of case

We discuss the case of 37-year-old man with a rapidly progressing PPAS, which was initially managed as PE. Imaging studies, particularly computed tomography and magnetic resonance imaging, were helpful in reaching the correct diagnosis. Because of the dismal prognosis of such cases, which improves by definite surgery, the patient underwent extensive surgical resection which got complicated by pulmonary reperfusion injury and intrapulmonary hemorrhage, and thus died.

Discussion

Owing to the rarity of the tumor, PPAS is often initially mistakenly diagnosed as PE, leading to a diagnostic delay and increased mortality. Having a high index of suspicion in “atypical PE” cases and a knowledge of the characteristic radiological and clinical features of PPAS may expedite the diagnosis and improve survival. Pulmonary artery distension by the mass on imaging studies and compression of neighboring structures are in favor of a tumor rather than PE. Additionally, tissue characterization on magnetic resonance imaging is particularly useful in differentiating tumor from PE. PPAS has a very poor prognosis which improves by early definitive surgery. Perioperative and late mortality however, remain high.

Conclusions

Physicians should be alert of this tumor despite its rarity because diagnostic delay increases mortality. In this report, we summarize the features that differentiate PPAS from PE and the importance of imaging in diagnosing the tumor.

Pulmonary artery sarcoma mimicking pneumonia: case report and literature review

Pulmonary artery sarcoma is a highly malignant and very rare tumor with a high rate of misdiagnosis. We present a case of a patient who complained of recurring fever for six months. He was diagnosed with pneumonia in a tertiary hospital in Nanjing and treated for more than one month, and was admitted with an initial diagnosis of pneumonia to our hospital. Pulmonary CT Angiography (CTPA) demonstrated pulmonary embolism. Until positron emission tomography-computed tomography (PET-CT) was performed, the patient was suspected to have pulmonary artery sarcoma (PAS). According to the histopathology from total left lung resection, he was eventually diagnosed with PAS and recovered very well. The prognosis of PAS depends very closely on early surgical treatment, and therefore physicians must be aware of PAS and grasp the best treatment opportunity.

Pulmonary artery sarcoma: Case report and review of the literature

Pulmonary artery sarcoma is a rare malignancy with poor prognosis which can be misdiagnosed as pulmonary thromboembolism. We present a case of a middle age woman who initially diagnosed with presumptive pulmonary embolism that was later found to have pulmonary artery sarcoma. Symptoms, pathology, imaging characteristics and available treatments are discussed.

Intraluminal Arterial Filling Defects Misdiagnosed as Pulmonary Emboli: What Else Could They Be?

Pulmonary artery filling defects can be observed in various pathologic processes other than pulmonary embolism, for example, nonthrombotic pulmonary embolism with biological and nonbiological materials and intrinsic pulmonary artery lesions. They have also been described in rare conditions, such as fibrosing mediastinitis and congenital absence or stenosis of pulmonary artery, and some pulmonary parenchymal and airway malignancies. Misdiagnosis is common owing to the relative rarity of these conditions. Correct diagnosis is based on the appropriate clinical suspicion considering the unique clinical features, laboratory findings, and additional radiologic clues inferring a pathology other than pulmonary embolism.

Clinical presentation and surgical treatment of primary pulmonary artery sarcoma

OBJECTIVES

Pulmonary artery sarcoma (PAS) is a rare and devastating disease. The diagnosis modality and optimal surgical strategy remain unclear. The aim of this study was to report our surgical experience in this disease.

METHODS

Between 2000 and 2017, 13 patients underwent operations for PAS at our institution. Five patients underwent tumour resection alone, whereas the other 8 patients received pulmonary endarterectomy. The medical records were retrospectively reviewed to evaluate the clinical characteristics, operative findings and the postoperative outcomes.

RESULTS

There were 2 perioperative deaths, both had unresolved severe pulmonary hypertension. Follow-up was completed for all patients with a mean duration of 14.3 months (1-48 months). During follow-up, 6 patients died after a mean survival time of 20.2 months (4-48 months). For the 5 patients alive at follow-up (mean duration of 7.2 months), 3 already had local recurrence. For all 13 patients, the cumulative survival rates at 1, 2 and 3 years were 56.4, 37.6 and 18.8%, respectively. The 8 patients treated with pulmonary endarterectomy seemed to have a better survival rate compared with the remaining 5 patients without endarterectomy, although the difference was not statistically significant.

CONCLUSIONS

Primary PAS is often mistaken for chronic pulmonary thromboembolism. Surgical intervention is the mainstay of treatment for PAS, but the prognosis after surgery remains poor. Compared to isolated tumour resection, pulmonary endarterectomy seemed to yield a better survival rate.

Intimal spindle cell sarcoma masquerading as adult-onset symptomatic pulmonic stenosis: a case report and review of the literature

Background

Pulmonary artery intimal spindle cell sarcomas are rare and carry with them a poor prognosis and high rate of recurrence. In extremely rare cases, this tumor can infiltrate the pulmonic valve and manifest as adult-onset pulmonic stenosis.

Case presentation

We report an unusual case of a patient with symptomatic, adult-onset severe pulmonic stenosis who was referred for possible balloon valvuloplasty but was subsequently found to have pulmonary artery intimal sarcoma infiltrating the pulmonary valve leading to progressive exertional dyspnea.

Conclusion

The presence of adult-onset pulmonic stenosis should prompt the clinician to investigate further as most cases of pulmonic stenosis are congenital in nature and present early in life. Careful diagnostic evaluation in concert with multimodal imaging should take place to arrive at the correct and challenging diagnosis of sarcoma-induced adult-onset severe pulmonic stenosis. Given the poor prognosis and rapid progression of disease, early diagnosis is crucial.

Electronic supplementary material

The online version of this article (10.1186/s13019-017-0654-9) contains supplementary material, which is available to authorized users.

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Zusammenfassung. Wir stellen den Fall einer 52-jährigen Frau vor, die initial mit Husten und leichten Brustschmerzen in der Hausarztpraxis vorstellig wurde. Bei stetiger Progression der Beschwerden wurde eine CT-Thorax durchgeführt, wobei eine ausgedehnte Lungenembolie festgestellt wurde. Nach Beginn einer oralen Antikoagulation zeigte sich keine Besserung der Beschwerden. Durch weiterführende Diagnostik mit MRI und PET-CT wurde schliesslich der Verdacht auf ein Pulmonalissarkom gestellt. Es erfolgte die operative Entfernung mittels pulmonaler Tumor-Endarteriektomie. In der Histologie zeigte sich ein R1-Resektat eines intimalen Sarkoms, weshalb zusätzlich eine additive Chemotherapie durchgeführt wurde. Trotz multimodaler Therapie und anfänglich erfreulichen klinischen Verlaufskontrollen kam es im weiteren Verlauf zur Krankheitsprogredienz, sodass weitere Metastasektomien pulmonal sowie auch im Grosshirn frontal und temporal folgten. Zudem wurde eine Radiotherapie des Ganzhirns durchgeführt. 31 Monate nach Diagnosestellung lebt die Patientin noch.

Pulmonary artery sarcoma presenting as an isolated lung mass

We report a very rare case of pulmonary artery sarcoma that presented as an isolated lung mass, which we attempted to resect via lobectomy, although this resulted in incomplete resection due to unnoticed latent proximal presentations. A 54-year-old man complained of a dry cough that had persisted for 2 months. Enhanced chest computed tomography revealed a lobular mass in his left lower lobe. Therefore, left lower lobectomy was performed as a radical surgery, and the tumor was ultimately diagnosed as pulmonary artery sarcoma. However, follow-up computed tomography at 16 months revealed proximal presentations in the pulmonary trunk and right pulmonary artery, which we retrospectively discovered were present before the surgery. This case highlights the importance of evaluating the lumen of the pulmonary artery, to accurately determine the required extent of any radical surgery, even in cases of pulmonary artery sarcoma that presents as an isolated lung mass.

Presentation and management of pulmonary artery sarcoma

BACKGROUND

Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy that leads to heart failure and death without treatment. Here we reviewed the presentation and management of patients treated at a national centre for pulmonary endarterectomy (PEA) and its associated hospital in Cambridge, UK.

METHODS

Details of PAS patients treated at Papworth and Addenbrooke's Hospitals between 2000 and 2014 were reviewed.

RESULTS

Twenty patients were diagnosed with PAS (11 males, 9 females), with a median age of presentation of 57 years (range 27-77). Presenting symptoms include dyspnoea (20), chest pain/tightness (7), oedema (5), constitutional symptoms (5), cough (3) and haemoptysis (3). Twelve patients were in group III/IV of the NYHA functional classification of symptoms. Initial CT scans were suggestive of thromboembolism in seven patients. Histological findings were of intimal sarcoma (13) and high grade sarcoma NOS (6). Median overall survival (OS) was 17 months. Fourteen patients underwent PEA to relieve vascular obstruction, while six had inoperable and/or metastatic disease. There were three peri-operative deaths. Although there was no difference in median OS between patients who had PEA and those who did not (20 vs 17 months, P = 0.2488), surgery provided significant symptomatic improvement and some with long-term survival. Five patients received post-surgical chemotherapy (anthracycline +/- ifosfamide), and after completion four also had radiotherapy. Patients who received post-operative chemo- and radio-therapy showed a trend towards better survival compared to those who had surgery alone (24 vs 8 months, P = 0.3417). For palliative chemotherapy, partial responses were observed with the VID regimen and pegylated liposomal doxorubicin. Stable disease was achieved in a patient with intimal sarcoma with rhabdomyosarcomatous differentiation on third-line cisplatin and topotecan. The longest surviving patient (102 months) has had PEA, adjuvant epirubicin and radiotherapy. She developed lung metastases 7 years later, which were treated with radiofrequency ablation.

CONCLUSIONS

PAS often presents with symptoms mimicking pulmonary hypertension, heart failure or thromboembolic disease. PEA provides good symptomatic relief and in some cases, offers a chance of long-term survival. Although outcome appears to be better when PEA is combined with post-operative chemo- and radio-therapy, further studies are warranted.

Pulmonary artery sarcoma successfully treated by right pneumonectomy after definitive diagnosis

Pulmonary artery sarcoma (PAS) is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy. Early diagnosis and radical surgical resection offer the only chance for survival. However, making a preoperative histopathological diagnosis is quite difficult. We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism. After confirming a definitive diagnosis using a catheter suction biopsy, we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass. Eighteen months after surgery, no recurrence was observed.

Pulmonary Artery Leiomyosarcoma Diagnosed without Delay

A 63-year-old female presented with abnormal lung shadows but had, apart from this, few symptoms. Computed tomography (CT) revealed multiple nodules and blockage of the pulmonary artery. She was immediately diagnosed with pulmonary artery sarcoma based on a careful differential diagnosis and underwent surgery. Her tumor was pathologically diagnosed as leiomyosarcoma (i.e. intimal sarcoma). Pulmonary artery sarcoma can be easily confounded with thromboembolism in a clinical setting and some cases are diagnosed post mortem only. In our case, clinical prediction scores (Wells score, Geneva score, and revised Geneva score) for the pulmonary embolism showed low probability. Moreover, chest CT showed uncommon findings for pulmonary thromboembolism, as the nodules were too big for thrombi. Because surgical resection can provide the only hope of long-term survival in cases of pulmonary artery sarcoma, clinicians should consider this possibility in the differential diagnosis of pulmonary embolism. Clinical prediction scores and CT findings might help to reach the correct diagnosis of pulmonary artery sarcoma.