Left Upper Lobe Mass Research Articles

Primary Pulmonary Rhabdomyosarcoma in Adults: Case Report and Review of Literature

A 38-year-old man, a chronic smoker, presented to us with a large left upper lobe mass lesion and left-sided pleural effusion. After resection, a residual mass remained. On histopathologic examination, a diagnosis of pleiomorphic rhabdomyosarcoma stage III of the lung was made. Chemotherapy using IRS (Intergroup Rhabdomyosarcoma Study) IV protocol with radiation therapy (RT) at week 9 was planned. The tumor progressed within 6 weeks of chemotherapy to involve the diaphragm and the pericardium (inoperable disease). Chemotherapy was abandoned, and we referred the patient to receive RT, which the patient refused; and he died of progressive disease 1 month later. The poor response to chemotherapy suggests that alternative treatment modalities including RT/second-look surgery or novel chemotherapeutic strategies should be tried in such a case.

Lung Cancer Presenting With a Solitary Colon Metastasis Detected on Positron Emission Tomography Scan

The patient is a 60-year-old man with a history of tobacco use (80 pack-years) who presented with a history of a cough of several months’ duration, occasionally productive of bloodtinged sputum. As part of the evaluation of these symptoms, a chest x-ray was performed, which revealed hilar fullness. As a result of this finding a computed tomography (CT) scan was performed, which revealed a left upper lobe mass surrounding the left main stem bronchus to the level of the carina, and the pulmonary artery without evidence of mediastinal lymphadenopathy. The patient was evaluated by the thoracic surgery service and determined to be unresectable. A positron emission tomography (PET) -CT scan was performed, which revealed increased [18]fluorine fluorodeoxyglucose (FDG) uptake in the left hilar mass, and focally increased uptake in the ascending colon (Fig 1), and no increased uptake in the mediastinal lymph nodes. The differential diagnosis for the focal area of increased FDG uptake in the colon was abscess, adenomatous polyps, hamartomatous adenoma, colonic primary, and metastatic lesion. The patient had a colonoscopy performed 2 years before presentation, which did not reveal any evidence of malignancy. A repeat colonoscopy was performed, which revealed a mass in the ascending colon (Fig 2), and biopsy revealed squamous cell carcinoma consistent with a lung primary. The patient’s clinical stage changed from stage III (T4N0M0) to histologic stage IV, and the patient’s treatment plan changed from chemoradiotherapy with curative intent to chemotherapy. In patients with clinical stage III disease, PET scanning will detect extrathoracic metastases in approximately 25% of patients. Patients who are being considered for surgical resection or chemoradiotherapy with extrathoracic areas of increased FDG uptake detected on PET scan should have a pathologic evaluation of the suspected lesions. A pathologic evaluation of solitary lesions is especially important. A recent retrospective review of patients with non–small-cell lung cancer (NSCLC) found that solitary extrapulmonary lesions were observed on PET-CT imaging in 21% of patients, and 46% of the lesions were either another malignancy, benign tumors, or inflammatory conditions. Previously the colon was not considered a frequent site of metastases for NSCLC; however, PET scanning may reveal a higher incidence of colonic metastases than previously suspected. The optimal management of patients with a solitary lesion detected on PET scan is unclear. Data exist that a proportion of patients with solitary brain or adrenal metastasis may experience prolonged survival with resection of both the primary and solitary metastatic lesion. Whether long-term survival is possible with resection of lung primary and solitary visceral metastasis is not known.

Massive Systemic Air Embolism Treated with Hyperbaric Oxygen Therapy Following CT-guided Transthoracic Needle Biopsy of a Pulmonary Nodule

A rare complication of computed tomography (CT)-guided biopsies of pulmonary lesions is systemic air embolism, with hyperbaric oxygen therapy being considered the mainstay of therapy. The authors describe the case of a 47-year-old man with a left upper lobe mass invading the chest wall who underwent CT-guided needle biopsy of a right lung base nodule to evaluate for metastatic disease. This procedure was complicated by massive systemic air embolism confirmed by CT scan. After initial resuscitative measures, the patient received on-site hyperbaric oxygen therapy and demonstrated no residual clinical sequelae from this complication.

Percutaneous Lung Biopsy in a Patient with a Cavitating Lung Mass: Indications, Technique, and Complications

2Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA. Case History A 75-year-old man was admitted to the hospital with an acute myocardial infarction. The patient was a former heavy smoker. A chest radiograph revealed a left apical lung mass (Fig. 1). A CT scan showed a cavitary left upper lobe lung mass measuring 3.5 × 4 cm (Fig. 2A) with an additional 3 × 2 cm mass at the left hilum (Fig. 2B). A wholebody PET scan showed the left upper lobe mass and at the left hilum, increased 18F-FDG uptake that was suggestive of lung neoplasm metastatic to the left hilum (Fig. 3). Therefore, a thoracic radiologist was consulted for biopsy of the left upper lobe lung mass. Dr. Titton. It is interesting to note that a PET scan was obtained for this patient. What is the role of 18F-FDG PET in the evaluation of patients with a pulmonary nodule or lung cancer? Dr. Kalra. In the evaluation of patients with a solitary pulmonary nodule, 18F-FDG PET improves characterization of the nodule by estimating the probability of malignancy. The high positive predictive value for malignancy in nodules greater than 1 cm in diameter suggests that those with positive scan results should undergo either percutaneous biopsy or surgical resection. Histologic examination of PET-positive lesions is necessary because false-positive PET findings can be encountered with granulomatous lesions secondary to sarcoidosis, tuberculosis, or infection [1]. False-negative PET findings are seen in patients with small lesions (< 1 cm) and in selected malignancies, such as bronchioalveolar cell carcinoma or well-differentiated adenocarcinoma or carcinoid tumor. For this reason, regardless of PET findings,

A Case Report of a Bronchogenic Cyst Misconceived to Lung Cancer

Bronchogenic cysts are generally presented as a well defined mass that have thin and smooth wall in the intrapulmonary or mediastinal area by simple chest radiographs. We present the case of a 20-year-old man with a ill-defined left upper lobe mass, found by chest radiographs. At the preoperative examinations, chest computed tomography showed ill-defined mass with Hounsfield Number 26, and nonspecific findings were shown by the bronchoscopy and percutaneous needle aspiration. The patient was undertaken the left upper lobectomy. The surgical specimen contained a ill-defined mass, measuring 2×3 cm. On the section of the mass, a cyst containing dark brown thick materials was noted. The cyst was unilocular, and the wall showed a trabeculation. Microscopically, the cystic mass was lined with ciliated pseudostratified columnar epitheliums and surrounded by smooth muscle and cartilage. (Tuberculosis and Respiratory Diseases 2003,

Left Upper Lobe Mass and Diffuse Reticular-Nodular Infiltrate

We encountered a clinical problem in a young man who presented with a left upper lobe mass and a diffuse reticular-nodular infiltrate. We thought we had appropriately applied Murphy's Law (the famed bank robber who "went where the money is"), and Ockham's Razor (the philosopher William of Ockham [1285 to 1349]-"Entities are not to be multiplied beyond necessity") as we rapidly diagnosed the lung mass with computed tomography, scintigraphy, and fine-needle aspiration. However, when his invaluable previous chest radiographs arrived, bronchoscopy with transbronchial biopsy, bronchoalveolar lavage, brushings, and postbronchoscopy sputum revealed the more ominous diagnosis in this patient. This case illustrates the complementary nature of current imaging and bronchoscopy techniques; but, even more importantly, it demonstrates the value of the history coupled with the previous radiograph. Even an unusual case can provide lessons in cost containment.