Mass In Right Hemithorax Research Articles

Immunocytochemistry as a Diagnostic Procedure of Pleural Mesothelioma

Background: Mesothelioma is a primary malignant tumor arising from the mesothelial surface of the pleura, peritoneal, tunica vaginalis, and pericardium. Most cases of mesothelioma originate from the pleura. Most patients have a history of asbestos exposure. A common diagnostic problem is distinguishing mesothelioma from adenocarcinoma since both tumors invade the pleura. Immunocytochemistry of calretinin and TTF-1 can be used to establish the diagnosis of mesothelioma.Case: Male, 56 years old presented with chest pain, shortness of breath, cough, and weight loss since 5 months before hospitalization. The patient had a history of occupational exposure to asbestos for 30 years. The movement and breath sounds were decreased as well as dull upon percussion at the right chest. A chest X-ray revealed a right lung tumor with pleural effusion. Thorax CT scan suggested pleural mass in right hemithorax, infiltration to intercostal muscles, and destruction of the 7th right rib, right perihilar lymphadenopathy, right pleural effusion, and liver nodules according to mesothelioma T4N1M1 Stage IV. Infiltrative stenting of the right and inferior lobe of the right lung, infiltrative and obstructive stenting of the medius lobe suggestive of a chronic malignancy and inflammation were found on FOB. Cytologic examination of pleural fluid, sputum, and Washing-and-brushing of FOB were a class II (no malignant cells). USG-guided transthoracic FNAB revealed adenocarcinoma with differential diagnosis of mesothelioma. Immunocytochemistry with calretinin showed positive results and TTF-1 showed a negative result. These confirmed the diagnosis of pleural mesothelioma T4N1M1 Stage IV. The patient showed a stable response from carboplatin/gemcitabine treatment.Keyword : Mesothelioma, Immunocytochemistry, TTF-1, Calrenitin

Cirurgia Citorredutora e Quimioterapia Intraperitoneal Hipertérmica para Tratamento de Tumor Desmoplásico de Pequenas Células Redondas em Paciente Pediátrico: Relato de Caso

Introdução: O tumor desmoplásico de pequenas células redondas (TDPCR) é uma neoplasia rara com comportamento clínico agressivo. Trata-se do caso de um paciente com 7 anos de idade, sexo masculino, com TDPCR, matriculado no Serviço de Pediatria do Instituto Nacional de Câncer José Alencar Gomes da Silva. Relato do caso: Paciente iniciou o quadro com queixa de dor e aumento do abdome, ascite volumosa, febre e emagrecimento. Nos exames de imagem, apresentava lesão hipodensa no segmento IV A do fígado, ascite volumosa, massa justa parietal no hemitórax direito. O laudo histopatológico foi compatível com TDPCR estádio IV. O paciente foi submetido à quimioterapia sistêmica com resposta completa nas lesões torácicas e redução importante da massa abdominal, restando lesões em cavidade pélvica. O paciente foi submetido à cirurgia com citorredução e hipertermoquimioterapia com cisplatina, e recebeu radioterapia abdominal adjuvante e quimioterapia. O paciente manteve-se estável, apresentando nova progressão e óbito 14 meses após a recidiva. Conclusão: A citorredução cirúrgica associada à hipertermoquimioterapia intraperitoneal permitiu a possibilidade de controle temporário da doença com boa qualidade de vida para o paciente.

A rare case of malignant solitary fibrous tumour of pleura with Doege-Potter syndrome

Solitary fibrous tumour of pleura (SFTP) is a rare tumor contributing to less than 5% of all pleural tumours and about 10% 30% of these tumours show features of malignancy. Occurrence of hypoglycaemia with solitary fibrous tumour is an unusual paraneoplastic syndrome designated as Doege-Potter syndrome which can occur both in benign and malignant tumours. Very few cases of solitary fibrous tumour with Doege-Potter syndrome are documented in world literature and only a couple of cases are documented in Indian literature so far. We, report here an interesting case of 40-year-old male who presented with a short history of weakness in left upper and lower limbs following an ischaemic stroke; breathlessness, productive cough, seizures and repeated episodes of loss of consciousness. Laboratory investigation revealed normal serum C-peptide level (1.04 ng/mL) and his blood sugar level was observed to be low varying from 25 mg/dL to 47 mg/dL. Computed tomography (CT) of lung and pleura showed a large mass in right hemithorax for which he underwent right hemithoracotomy. Histopathological examination of the resected thoracotomy specimen along with immunohistochemical analysis confirmed the diagnosis of malignant solitary fibrous tumour of pleura. Basing on the clinical, histopathological and immunohistochemical examination findings, the case was finally diagnosed as malignant solitary fibrous tumour of pleura with Doege-Potter syndrome. The clinico-pathological features and therapeutic management of such rare syndrome are being discussed here.

Oleothorax Simulating Pulmonary Neoplasm

An 84-year-old woman presented with a dry cough that had persisted for 4 months. A chest radiograph showed a mass in the right hemithorax. Owing to suspected lung cancer, the patient underwent computed tomography, which demonstrated a heterogeneous mass in the upper right hemithorax containing calcifications and fat (Fig 1). The patient reported receiving an oil injection into the pleural cavity (oleothorax) to treat tuberculosis 60 years previously. Aspirated pleural viscous fluid proved to be mineral oil.