Lingular Segment Research Articles

Risk Factors for Locoregional Relapse After Segmentectomy: Supplementary Analysis of the JCOG0802/WJOG4607L Trial

IntroductionThe JCOG0802/WJOG4607L trial revealed superior overall survival in segmentectomy compared with lobectomy for small-peripheral NSCLC. Nevertheless, locoregional relapse (LR) is a major issue for segmentectomy. An ad hoc supplementary analysis aimed to determine the risk factors for LR and the degree of advantages of segmentectomy on the basis of primary tumor sites. MethodsParticipants in multi-institutional and intergroup, open-label, phase 3 randomized controlled trial in Japan were enrolled from August 10, 2009, to October 21, 2014. Risk factors for LR after segmentectomy and clinical features following the primary tumor site were investigated. ResultsOf 1105 patients, 576 and 529 underwent lobectomy and segmentectomy, respectively. The primary tumor site for segmentectomy was the left upper division, left lingular segment, left S6, left basal segment, right upper lobe, right S6, or right basal segment. Multivariable analysis in the segmentectomy group revealed that pure-solid appearance on thin-section computed tomography (OR = 3.230; 95% confidence interval [CI]: 1.559–6.690; p = 0.0016), margin distance less than the tumor size (OR = 2.682; 95% CI: 1.350–5.331; p = 0.0049), and male sex (OR = 2.089; 95% CI: 1.047–4.169; p = 0.0366) were significantly associated with LR. Patients with left lingular segment tumors (OR = 4.815; 95% CI: 1.580–14.672) tended to experience LR more frequently than those with left upper division tumors, although primary tumor sites were not statistically significant. ConclusionsThin-section computed tomography findings and margin distance are important factors to avoid LR in segmentectomy.

Increased Scan Speed and Pitch on Ultra-Low-Dose Chest CT: Effect on Nodule Volumetry and Image Quality.

Background and Objectives: This study's objective was to investigate the influence of increased scan speed and pitch on image quality and nodule volumetry in patients who underwent ultra-low-dose chest computed tomography (CT). Material and Methods: One hundred and two patients who had lung nodules were included in this study. Standard-speed, standard-pitch (SSSP) ultra-low-dose CT and high-speed, high-pitch (HSHP) ultra-low-dose CT were obtained for all patients. Image noise was measured as the standard deviation of attenuation. One hundred and sixty-three nodules were identified and classified according to location, volume, and nodule type. Volume measurement of detected pulmonary nodules was compared according to nodule location, volume, and nodule type. Motion artifacts at the right middle lobe, the lingular segment, and both lower lobes near the lung bases were evaluated. Subjective image quality analysis was also performed. Results: The HSHP CT scan demonstrated decreased motion artifacts at the left upper lobe lingular segment and left lower lobe compared to the SSSP CT scan (p < 0.001). The image noise was higher and the radiation dose was lower in the HSHP scan (p < 0.001). According to the nodule type, the absolute relative volume difference was significantly higher in ground glass opacity nodules compared with those of part-solid and solid nodules (p < 0.001). Conclusion: Our study results suggest that HSHP ultra-low-dose chest CT scans provide decreased motion artifacts and lower radiation doses compared to SSSP ultra-low-dose chest CT. However, lung nodule volumetry should be performed with caution for ground glass opacity nodules.

Lung Involvement Patterns in COVID-19: CT Scan Insights and Prognostic Implications From a Tertiary Care Center in Southern India.

Background COVID-19, caused by the SARS-CoV-2 virus, has presented an unparalleled challenge and a profound learning curve globally. Among the myriad of investigative tools, CT scans of the chest have become instrumental in assessing the magnitude of lung involvement in the pathogenesis of this disease. Objectives This study aimed to evaluate the distribution and patterns of lung involvement depicted in the CT chest scans of COVID-19 patients admitted to a specialized tertiary care center located in a southern state of India. Methods With clearance secured from the Institutional Ethics Committee, an analytical cross-sectional study was conducted. It encompassed CT chest images from all symptomatic COVID-19 patients within the designated study center during the specified study timeline. Subsequent data analysis ensued. Results Among the 1066 COVID-19 patients evaluated, ground-glass opacities (GGO) were the predominant lung involvement pattern. Distinct patterns, such as GGOs combined with solid consolidation or atelectasis, were noted, with the highest mortality linked to GGOs paired with pneumomediastinum (PM). Data underscored a direct correlation between the extent of lung involvement and patient prognosis, with specific lung regions, namely the right apical, right posterior, right superior basal, left superior lingular, and left inferior lingular segments, showing frequent involvement. Conclusion Amidst the pandemic, our study emphasizes that ground-glass opacities on CT scans are robust indicators of COVID-19 in RT-PCR-positive patients. Early identification can enhance patient management, with findings highlighting a strong link between lung involvement and prognosis. This insight aids in refining patient triage, while further research is warranted to delve deeper into variations in lung involvement and guide treatment advancements.

Three-dimensional analysis reveals a high incidence of lung adenocarcinoma in the upper region.

The lung is a unique organ with a ventilation-perfusion mismatch, which can cause inhomogeneous incidence rates of lung cancer depending on the location in the lung. We aimed to evaluate the incidence of lung adenocarcinoma in each lobe by analyzing the incidence per unit volume, to evaluate the incidence without being affected by differences in the size of each lobe or in the size of the lungs between individuals. The number of adenocarcinomas in each lobe was counted. Lung volumes were measured using a three-dimensional computer workstation. The tumor incidence per unit volume was analyzed based on the number of tumors in each lobe. The number of tumors per unit volume was 0.467 in the right upper lobe (RUL), 0.182 in the right middle lobe, 0.209 in the right lower lobe, 0.306 in the left upper segment (LUS), 0.083 in the left lingular segment, and 0.169 in the left lower lobe. The tumor incidence rate of RUL + LUS was 2.269 times that of the other lobes, a value that was significantly higher when using the bootstrap method (p < 0.001). The incidence of adenocarcinoma per unit volume in both upper lobes was higher than that in other lobes.

Enlarging pulmonary cyst: a rare form of alveolar adenoma

BackgroundAlveolar adenoma is a rare benign tumour, usually presenting as a peripherally located solid mass, sometimes mimicking malignancy.Case presentationA 37-year-old woman presented with chronic intermittent vague chest discomfort. The chest x-ray showed a simple cyst in the left lower lung field, and serial computed tomography (CT) over the following 2-year period showed rapid growth of the cyst, from 3.5 to 9.0 cm in diameter. The CT scan suggested bronchiolar communication, which was suspected to be the cause of growth, via check-valve mechanism. Thoracoscopic surgery was performed, and we found a thin-walled cyst in the lingular segment. Wedge resection was performed and the pathology was an unexpected alveolar adenoma which had grown on the terminal bronchiole, causing the alveolus to rupture and the cyst to grow. In 48 months of follow-up, there was no evidence of recurrence and the patient’s symptoms resolved.ConclusionsRapidly growing pulmonary cysts can lead to complications including rupture with pneumothorax and haemothorax, and surgery is always indicated. Abnormally rapid growth may indicate an underlying pathology such as alveolar adenoma. Surgical resection is the treatment of choice and there have been no reported cases of recurrence. Here we present a rare form of alveolar adenoma, which was a form of rapidly growing pulmonary cyst.

Bronchopulmonary Carcinoid: A Case Report and Brief Review

A 45 years old female presented with mild persistent nonproductive cough since past oneyear, andshortness of breath (SOB) with recently detected hypertension and diabetes since 3 months. The patient also mentioned hot flushes since last one month. She remained on home quarantine without oxygen support for COVID-19 in the year 2020. She was advised anti-TB in 2021which she stopped due to intolerance. All routine investigations were essentially normal except RBS 160 mg/dl and HbA1C which was 8.5%. She was regularly taking antihypertensive and anti-diabetic drugs. Chest x-ray revealed left cardiac silhouette due to collapse of lingular segment, which was confirmed with CECT thorax. BAL, brush cytology and biopsy were carried out with fiberoptic bronchoscopy, revealing a smooth polypoid mass obstructing the lingular segmental bronchus. Histopathology reported it as a typical carcinoid. The case was referred for surgical intervention. There was a delay in diagnosis in this case, as there was past history of COVID-19 infection and was misinterpreted as its sequelae; wrong diagnosis and empirical treatment for tuberculosis and the association of diabetes and systemic hypertension makes this case worthy for presentation.

Analysis of variations in the bronchovascular pattern of the lingular segment to explore the correlations between the lingular segment artery and left superior division veins.

With the development of anatomical segmentectomy, the thoracic surgeons must master the anatomical variations of the pulmonary bronchi and vessels. However, there are only a few reports showing anatomic variations of the lingular segment (LS) using three-dimensional computed tomography bronchography and angiography (3D-CTBA). Thus, the present study aimed to analyze the bronchovascular patterns of the LS and explore the correlation between the lingular segment artery (LSA) and left superior division veins (LSDV). The 3D-CTBA data of the left upper lobe (LUL) were collected from patients who had undergone lobectomy or segmentectomy at Hebei General Hospital between October 2020 and October 2022. We reviewed the clinical characteristics and variations in bronchi and pulmonary vessels and grouped them according to different classifications. Among all 540 cases of 3D-CTBA, the branching patterns of LSA included 369 (68.3%) cases with the interlobar origin, 126 (23.3%) cases with the interlobar and mediastinal origin, and 45 (8.3%) cases with the mediastinal origin. The branching pattern of LSDV could be classified into three forms: Semi-central vein type (345/540, 63.9%), Non-central vein type (76/540, 14.1%), and Central vein type (119/540, 22.0%). There were 51 cases (9.4%) with Non-central vein type, 50 cases (9.3%) with Central vein type, 268 cases (49.6%) with Semi-central vein type in the interlobar type, and 7 cases (1.3%) with Non-central vein type, 9 cases (1.7%) with Central vein type, 29 cases (5.4%) with Semi-central vein type in the mediastinal type. Moreover, the Non-central vein type, the Central vein type, and the Semi-central vein type accounted for 18 (3.3%), 60 (11.1%), and 48 (8.9%) in the interlobar and mediastinal type. Combinations of the branching patterns of the LSA and LSDV were significantly dependent (p < 0.005). The combinations of the interlobar and mediastinal type with the Central vein type, and the interlobar type and the mediastinal type with the Semi-central vein type were frequently observed. This study found the relationship between the LSA and LSDV and clarified the bifurcation patterns of the bronchovascular in the LS. Our data can be used by thoracic surgeons to perform safe and precise LS segmentectomy.

Bronchial tuberculosis with recurrent spontaneous pneumothorax: A case report

BackgroundSpontaneous pneumothorax associated with tuberculosis due to clinical manifestations, imaging findings and negative pleural biopsy is rare. Case reportA 43-year-old young woman went to the hospital several times because of recurrent dyspnea and was diagnosed with a right spontaneous pneumothorax. She underwent multiple closed thoracic drainage procedures, but the pneumothorax was not completely resolved. Pleural biopsy pathology was chronic inflammation; there was no evidence of tuberculosis. A small amount of pneumothorax persisted, intermittent dyspnea became more severe, and pneumothorax increased. Bronchoscopy showed thickening of the left lung lingular segment mucosa, and the bronchial lavage fluid gene X-PERT/rifampicin resistance test was positive. After one month of anti-tuberculosis treatment, the symptoms of short breath were completely relieved, and chest computerized tomography (CT) showed complete resolution of the right pneumothorax.ConclusionsWhen searching for the cause of spontaneous pneumothorax, people should not overlook tuberculosis-related secondary pneumothorax, which should be diagnosed and treated as soon as possible.

A Case of Suspected Negative Pressure Pulmonary Edema after General Anesthesia.

Negative pressure pulmonary edema (NPPE) can occur rapidly after the release of an upper airway obstruction. In general anesthesia, NPPE can be caused by laryngospasm after extubation. This report describes a case in which NPPE was thought to have occurred after extubation during general anesthesia in a disabled person. The patient was a 28-yearold man, 160 cm in height and 56 kg in weight, who was scheduled for dental caries treatment under ambulatory general anesthesia due to intellectual disability. After induction of general anesthesia, nasal intubation was performed after sufficient oral suctioning to remove a large amount of serous secretion. After completion of dental treatment, pressurized extubation was performed after oral suctioning as sufficient spontaneous breathing and body movement were observed. Immediately after extubation, SpO2 dropped to 80%, subsequently recovering to 99% under oxygen administration at 5 liter/min with an oxygen mask. It dropped to approximately 85% again, however, when administration of oxygen was discontinued. Although communication with the patient was difficult, no expression of anguish or dyspnea was observed. A chest radiograph showed symmetric middle-lobe and lingular segment infiltrates, and the patient was transferred to the nearest general hospital. No obvious clinical findings other than a decrease in SpO2 were observed, suggesting NPPE as a result of airway narrowing due to secretions.

Lingular division of the left lung: Only superior and inferior bronchi?

The lingular segment bronchi usually bifurcate into superior lingular (B4 ) and inferior lingular (B5 ) segmental bronchi. We report 32 horizontally bifurcated lingular segment bronchi cases, analyzing the bronchovascular variations and the perioperative outcomes. All patients with pulmonary lesions underwent three-dimensional computed tomography bronchography and angiography between January 2019 and January 2022. The bronchovascular patterns were analyzed for each patient. A consecutive 5280 patients were included, and 32 cases of this malformation were identified. The incidence of the lateral (B4 ) and medial (B5 ) lingular segmental bronchi is 0.6%. The A4 and A5 arise separately in 21 (65.6%) patients. In 9 (28.1%) patients, the A4 a arises from the common trunk of A4 +5 . In 2 (6.3%) patients, the A4 arises from the interlobe artery, while A5 is a mediastinal lingular artery. The common trunk of V4 a + b is found in 19 (59.4%) patients. The V5 is the least changeable of the segmental bronchi veins. Among the 32 patients, five patients had an LS4 segmentectomy. The surgical details of the five patients are summarized. The laterally and medially bifurcated lingular bronchus pattern is a rare anomaly. It implies that the lingular bronchus is not only superiorly and inferiorly bifurcated.

LOCALIZED LARGE ENDOBRONCHIAL NON-HODGKIN LYMPHOMA PRESENTING WITH FEVER, DYSPNEA, AND HEMOPTYSIS

LOCALIZED LARGE ENDOBRONCHIAL NON-HODGKIN LYMPHOMA PRESENTING WITH FEVER, DYSPNEA, AND HEMOPTYSIS

Robotic segmentectomy using a lung base-flip approach.

Robotic segmentectomy using a lung base-flip approach.

Cryptogenic organizing pneumonia associated with pregnancy: A case report

BACKGROUNDCryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans organizing pneumonia, is an extremely rare disease in pregnancy. In this case, we report on COP diagnosed in recurrent pneumonia that does not respond to antibiotics in pregnant woman.CASE SUMMARYA 35-year-old woman with no prior lung disease presented with concerns of chest pain with cough, sputum, dyspnea, and mild fever at 11 wk’ gestation. She was diagnosed with community-acquired pneumonia and treated with antibiotics; her symptoms improved temporarily. Four weeks after discharge, she was re-admitted with aggravated symptoms. Chest computed tomography demonstrated multifocal patchy airspace consolidation and ground-glass opacities at the basal segments of the right lower lobe, at the lateral basal segment of the lower lobe, and at the lingular segment of the left upper lobe. Bronchoalveolar lavage revealed an increased lymphocyte count and a decreased CD4/CD8 ratio. Prednisolone (0.5 mg/kg/d) was administered for 10 d after the second admission. Dyspnea improved after 3 d of steroid treatment and other symptoms improved on the 5th day of steroid administration. Post-delivery transbronchial lung biopsy further revealed the presence of granulation tissue with fibroblasts in small-bronchiole lumens.CONCLUSIONThis case suggests that it is important to differentiate COP from atypical pneumonia in the deteriorated condition despite antibiotic treatment.

Patient-specific simulation for tracheobronchial reconstruction procedures using 3-dimensional operable models: A proof-of-concept study.

Patient-specific simulation for tracheobronchial reconstruction procedures using 3-dimensional operable models: A proof-of-concept study.

Penetrating chest trauma in Sauer's danger zone without serious heart or lung damage: An unusual case report.

Introduction and importanceSauer's danger zone is an area on the anterior chest where trauma is considered to cause heart and macrovascular injury. Herein, we report the case of an injured patient showing evidently fatal findings on chest radiography and computed tomography (CT) presenting almost no actual fatal injuries on surgical examination.Case presentationThe patient was an 86-year-old man who was found by a family member with a 30-cm knife blade stuck in his left front chest (Sauer's danger zone). On chest CT findings, the knife was observed to be inserted through the 4th intercostal space, penetrating the lungs. The tip of the knife appeared to be anchored to the dorsal side of the 9th intercostal space.Clinical discussionWe found no damage to the heart, only a 2-cm-long and 1-cm-deep cut in the lingular segment area.ConclusionWe confirmed that the amount of bleeding in the inserted drain was an indicator of non-macrovascular injury. In cases of chest trauma, chest tube drainage and hemodynamics should always be observed, and the potential need for emergency surgery should be considered.

Surgical Techniques of Y-Sleeve Lobectomy in Patients With Primary Lung Cancer.

The directions of distal and proximal airway stumps were different in Y-sleeve lobectomy. This difference might make Y-sleeve lobectomy a difficult procedure. In this article, we present our surgical techniques and analyse short-term outcomes of Y-sleeve lobectomy. Right middle and lower, left lower, and left lower and lingular segment sleeve lobectomies are categorized in Y-sleeve lobectomy. We retrospectively investigated the clinical courses of 17 patients who underwent Y-sleeve lobectomy from January 2017 to December 2020. No treatment-related deaths occurred. One patient developed a bronchopleural fistula. Four patients developed pneumonia and were cured by repeated bronchoscopies and antibiotic therapy. Three patients had retention of pleural effusion, and two had prolonged air leakage. One patient had empyema after prolonged air leakage and was cured by thoracic drainage and antibiotic therapy. A major complication was observed only in one patient. Y-sleeve lobectomy is a reliable surgical method to avoid pneumonectomy.

PULMONARY EMBOLISM CASES WHICH OCCURRED UNDER ENOXAPARIN SODIUM 4000 IU PROPHYLAXIS

TOPIC: Pulmonary Vascular Disease TYPE: Global Case Reports INTRODUCTION: Some surgical based guidelines recommends standart 4000 IU Enoxaparin for VTE prophylaxis. However fixed dose enoxaparin will often fail to achieve therapeutic levels, since for therapeutic anticoagulation, enoxaparin is dosed based on weight (1mg/kg). To draw attention to this issue, we presented 3 cases who developed PE while receiving 4000 IU Enoxaparin prophylaxis. CASE PRESENTATION: Cases Case 1:A 27-year-old, 72 kilogram male patient, who had no known chronic disease history, was using Enoxaparin sodium 4000 international units (IU) regularly once a day after the meniscus operation. Complaints of back pain and shortness of breath developed two weeks after the operation In the computed tomography pulmonary angiography(CTPA), filling defects in the middle and lower lobar branches of the right lung and extending to the lingular segment of the upper lobe of the left lung were seen. The patient was followed up in our department with the diagnosis of bilateral lobar pulmonary embolism (PE).Case 2:An 80-year-old 65-kilogram female patient with a known chronic obstructive pulmonary disease, atrial fibrillation (AF), hypertension, was using a new generation oral anticoagulant (NOAC) due to AF. NOAC was discontinued upon the development of ecchymotic lesions in the body, and Enoxaparin sodium 4000 IU was added to the treatment once a day.. Three weeks after the treatment change, the patient was admitted to the emergency department with the complaint of dyspnea, and a thrombus extending from the distal of both main pulmonary arteries to the bilateral lower and upper lobe bronchial artery was detected in the CTPA, and he was followed up in our service with the diagnosis of massive PE. DISCUSSION: Case 3: An 81 years old, 67-kilogram female patient with a diagnosis of hypertension and Alzheimer's disease admitted to the hospital with complaints of shortness of breath and swelling in the legs for a week. Seven months ago, Enoxaparin sodium 4000 IU was planned twice a day in an external center due to pulmonary embolism. The patient continued to use LMWH 4000 IU once a day after the 3rd month of his own request. CTPA revealed filling defects in the right pulmonary artery upper lobe posterior and lower lobe posterobasal segments. Lower extremity venous Doppler ultrasonography revealed deep vein thrombus (DVT). When compared with previous examinations, it was observed that pulmonary embolism had newly developed and the patient was followed up with segmental PE + DVT diagnoses. CONCLUSIONS: Although low-dose LMWH treatment is recommended in some guidelines and drug package insert for PE prophylaxis, the cases we have presented suggest that it would be safer to consider the patient's weight when administering LMWH prophylaxis. REFERENCE #1: Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature SearchVan N Tran 1, Ilya Varfolomeev 2, Geoff Hill 3 DISCLOSURES: No relevant relationships by MELTEM GUNDUZ, source=Web Response No relevant relationships by H.Canan Hasanoglu, source=Web Response

Complex segmentectomy is not a complex procedure relative to simple segmentectomy.

Segmentectomies can be classified as simple or complex and are increasingly performed for early-stage lung cancer. Complex segmentectomy requires the creation of multiple intersegmental planes and is considered a more arduous procedure with higher risks of postoperative complications, relative to simple segmentectomy. This retrospective study evaluated patients who underwent simple or complex segmentectomy for primary lung cancer during 2012-2018. Perioperative factors were compared according to the procedure type. The 538 eligible segmentectomies included 251 complex segmentectomies and 287 simple segmentectomies. There were no significant differences in terms of age, sex, smoking history or comorbidities. The most common procedure in the complex segmentectomy group was upper-lobe segmentectomy (e.g. S1, S2, S3 and S1 + 2; n = 170), which was followed by S8 segmentectomy (n = 39) and two-segment segmentectomies (e.g. S7 + 8, S8 + 9 and S9 + 10; n = 24). Simple segmentectomies involved left upper division (n = 117), the lingular segment (n = 30) and the S6 segment (n = 140). Comparing complex and simple segmentectomies revealed equivalent median operative times (113 vs 113 min) and blood loss (20 vs 20 ml). Complex segmentectomy had fewer postoperative complications (2.0% vs 7.0%, P = 0.006), including prolonged air leak (0.8% vs 3.5%, P = 0.035) and shorter median postoperative stays (3 vs 4 days, P < 0.001). However, median surgical margins were closer for complex segmentectomy (22 vs 25 mm, P = 0.005). The perioperative outcomes of complex segmentectomy were satisfactory and comparable to those of simple segmentectomy. Surgeons should pay careful attention to the surgical margins during complex segmentectomy.

Analysis of anatomical variations of the lingular artery of the left upper lobe using 3D computed tomography angiography and bronchography.

BackgroundThoracic surgeons must be familiar with the anatomy of the pulmonary artery during segmentectomy and segmentectomy. But pulmonary arteries have numerous variations and aberrant branching patterns. The purpose of the present study was to analyze the anatomical variations and frequencies of the lingular artery of the left upper lobe (LUL) using 3D computed tomography angiography and bronchography (3D-CTAB).MethodsWe retrospectively studied 166 patients having undergone lobectomy or segmentectomy from January to December 2020 at Fujian Medical University Cancer Hospital’s Department of Thoracic Surgery. All patients underwent 3D reconstruction using 3D-CTAB before surgery.ResultsThe lingular segment was supplied by 1 artery in 45.18% of cases, 2 arteries in 46.39% of cases, and 3 arteries in 8.43% of cases. The branching patterns of the lingular artery included 119 (71.68%) cases with interlobar origin, 35 (21.08%) cases with interlobar and mediastinal origin, and 13 (7.83%) cases with mediastinal origin. The interlobar lingular artery include superior lingular artery (A4) and inferior lingular artery (A5). The interlobar lingular artery type was A4a, A4b, A5 in 7.23% of cases; A4 and A4b+5 in 3.01% of cases; and A4b and A4a+5 in 4.82% of cases. The mediastinal lingular artery was divided into the following 5 types: ‘A4’, ‘A4b’, ‘A4b+5’, ‘A4b+5a’, and ‘A4+5’. The most common type was A4 (12.05%, 20/166) in 166 patients. The interlobar lingular artery had the following 5 patterns of variation: ‘A4+5’, ‘A4, A5’, ‘A4a, A4b, A5’, ‘A4a, A4b+5’, and ‘A4b, A4a+5’. The single interlobar lingular artery (A4+5) was the most common type in 38.55% of cases. In 24.10% of cases, A5 came from A8 or A8+9. Besides In 8.43% of cases, the origin of A5 was close to A8 or A8+9.ConclusionsWe identified the left various lingular artery branching patterns with 3D-CTAB in patients and defined the frequency of anatomic variations. 3D-CTAB is useful for finding these variations.

Sarcoma fibromixoide de bajo grado con metástasis pulmonares. Reporte de un caso raro

Background Low-grade fibromyxoid sarcoma is a very rare tumor that tends to develop in deep soft tissues of young adults and has the potential for local recurrence and distant metastasis. Clinical case We present the case of a 36-year-old man with a low-grade fibromyxoid sarcoma in the right shoulder, which was initially reported as a 4-year-old tumor, undergoing extensive resection with a histopathological report of low-grade fibromyxoid sarcoma, whose deep surgical edge was in bony contact. A simple and contrasted axial tomography was performed where an 8 mm left lung lesion was observed in the upper lobe lower lingular segment of heterogeneous content, hyperdense with contrast medium reinforcement. Left lateral thoracotomy is performed for metastasectomy and pathology corroborates the diagnosis of metastasis from fibromyxoid sarcoma. Conclusion Low histological fibromyxoid sarcoma is a very rare tumor that must be differentiated from other soft tissue tumors. Recurrences and metastases are reported, despite short or prolonged disease-free periods of up to 50 years, so patients with a history of this tumor should be followed up.