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Lung adenocarcinoma with peculiar growth to the pulmonary artery and thrombus formation: report of a case.

Goto T, Maeshima A, Kato R - World J Surg Oncol (2012)

Bottom Line: Although a large thrombus was found at the vessel invasion site of the adenocarcinoma in the pulmonary artery, there were no malignant findings in the thrombus itself.This is the first reported case of radical resection of a lung cancer with invasion along the pulmonary artery wherein a benign thrombus had formed.In general, surgery would be the treatment of choice for a pulmonary artery mass.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. taichiro@1997.jukuin.keio.ac.jp

ABSTRACT

Background: Cases of pulmonary artery masses have only rarely been reported, and the optimal type of the diagnosis and treatment is controversial.

Case presentation: An 81-year-old woman was found to have an abnormal shadow on chest X-ray film. Computed tomography showed an irregularly bordered tumor centered in the hilar region extending from segment 6 to the middle lobe of the right lung. Pulmonary angiography showed complete occlusion of the trunk at the periphery proximal to the bifurcation of the posterior ascending branch. Based on bronchoscopic biopsy of the tumor, an adenocarcinoma was diagnosed. Middle and lower lobectomy was performed. Histopathologically, the adenocarcinoma had invaded the tunica intima of the pulmonary artery and also replaced the endothelium in the same region. Although a large thrombus was found at the vessel invasion site of the adenocarcinoma in the pulmonary artery, there were no malignant findings in the thrombus itself.

Conclusions: This is the first reported case of radical resection of a lung cancer with invasion along the pulmonary artery wherein a benign thrombus had formed. In general, surgery would be the treatment of choice for a pulmonary artery mass.

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Radiological findings. A: Chest X-ray showed a mass shadow in the right middle lung field. B, C: Chest CT showed a tumor with an irregular border centered in the hilar region extending from S6 to the middle lobe of the right lung. Stenosis and occlusion of the pulmonary artery were found on mediastinal window setting. D: Positron emission tomography showed fluorodeoxyglucose uptake in the tumor. E: Angiography showed complete occlusion of the pulmonary trunk at the periphery proximal to the bifurcation of the posterior ascending branch, and a filling defect at the root of this branch.
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Figure 1: Radiological findings. A: Chest X-ray showed a mass shadow in the right middle lung field. B, C: Chest CT showed a tumor with an irregular border centered in the hilar region extending from S6 to the middle lobe of the right lung. Stenosis and occlusion of the pulmonary artery were found on mediastinal window setting. D: Positron emission tomography showed fluorodeoxyglucose uptake in the tumor. E: Angiography showed complete occlusion of the pulmonary trunk at the periphery proximal to the bifurcation of the posterior ascending branch, and a filling defect at the root of this branch.

Mentions: An 81-year-old woman was found to have an abnormal shadow in the right lower lung field on chest radiography for a routine health check-up (Figure 1A). Her past medical history was unremarkable. Her smoking history was 1 pack/day × 50 years, and she had quit smoking at age 70. Chest computed tomography (CT) showed a tumor with an irregular border centered in the hilar region extending from segment 6 (S6) to the middle lobe of the right lung (Figure 1B, C). Based on stenotic and occlusive findings of the pulmonary artery on CT scan, the tumor was considered to have directly invaded the pulmonary trunk (Figure 1B, C). Although positron emission tomography showed fluorodeoxyglucose uptake with a maximum standard uptake value of 4.7 in the tumor region (Figure 1D), there was no fluorodeoxyglucose uptake in mediastinal lymph nodes or other organs. To closely examine the extent of proximal intravascular tumor invasion, angiography was performed, which revealed complete occlusion of the pulmonary trunk at the periphery proximal to the bifurcation of the posterior ascending branch, and a filling defect at the root of this branch (Figure 1E). Although bronchoscopy showed no mass lesion in the visible range, adenocarcinoma was diagnosed by bronchoscopic biopsy of the tumor. The level of carcinoembryonic antigen was elevated, at 5.7 ng/mL (institutional cutoff value, 5.0 ng/ml); however, no abnormalities were detected in other blood chemistry or tumor marker levels. The patient was otherwise healthy and asymptomatic. Her vital capacity was 1.92 liters, and her forced expiratory volume in 1 second was 1.40 liters. Because right pneumonectomy would be difficult given her pulmonary function and age, preservation of the right upper lobe was chosen as the surgical strategy.


Lung adenocarcinoma with peculiar growth to the pulmonary artery and thrombus formation: report of a case.

Goto T, Maeshima A, Kato R - World J Surg Oncol (2012)

Radiological findings. A: Chest X-ray showed a mass shadow in the right middle lung field. B, C: Chest CT showed a tumor with an irregular border centered in the hilar region extending from S6 to the middle lobe of the right lung. Stenosis and occlusion of the pulmonary artery were found on mediastinal window setting. D: Positron emission tomography showed fluorodeoxyglucose uptake in the tumor. E: Angiography showed complete occlusion of the pulmonary trunk at the periphery proximal to the bifurcation of the posterior ascending branch, and a filling defect at the root of this branch.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3278376&req=5

Figure 1: Radiological findings. A: Chest X-ray showed a mass shadow in the right middle lung field. B, C: Chest CT showed a tumor with an irregular border centered in the hilar region extending from S6 to the middle lobe of the right lung. Stenosis and occlusion of the pulmonary artery were found on mediastinal window setting. D: Positron emission tomography showed fluorodeoxyglucose uptake in the tumor. E: Angiography showed complete occlusion of the pulmonary trunk at the periphery proximal to the bifurcation of the posterior ascending branch, and a filling defect at the root of this branch.
Mentions: An 81-year-old woman was found to have an abnormal shadow in the right lower lung field on chest radiography for a routine health check-up (Figure 1A). Her past medical history was unremarkable. Her smoking history was 1 pack/day × 50 years, and she had quit smoking at age 70. Chest computed tomography (CT) showed a tumor with an irregular border centered in the hilar region extending from segment 6 (S6) to the middle lobe of the right lung (Figure 1B, C). Based on stenotic and occlusive findings of the pulmonary artery on CT scan, the tumor was considered to have directly invaded the pulmonary trunk (Figure 1B, C). Although positron emission tomography showed fluorodeoxyglucose uptake with a maximum standard uptake value of 4.7 in the tumor region (Figure 1D), there was no fluorodeoxyglucose uptake in mediastinal lymph nodes or other organs. To closely examine the extent of proximal intravascular tumor invasion, angiography was performed, which revealed complete occlusion of the pulmonary trunk at the periphery proximal to the bifurcation of the posterior ascending branch, and a filling defect at the root of this branch (Figure 1E). Although bronchoscopy showed no mass lesion in the visible range, adenocarcinoma was diagnosed by bronchoscopic biopsy of the tumor. The level of carcinoembryonic antigen was elevated, at 5.7 ng/mL (institutional cutoff value, 5.0 ng/ml); however, no abnormalities were detected in other blood chemistry or tumor marker levels. The patient was otherwise healthy and asymptomatic. Her vital capacity was 1.92 liters, and her forced expiratory volume in 1 second was 1.40 liters. Because right pneumonectomy would be difficult given her pulmonary function and age, preservation of the right upper lobe was chosen as the surgical strategy.

Bottom Line: Although a large thrombus was found at the vessel invasion site of the adenocarcinoma in the pulmonary artery, there were no malignant findings in the thrombus itself.This is the first reported case of radical resection of a lung cancer with invasion along the pulmonary artery wherein a benign thrombus had formed.In general, surgery would be the treatment of choice for a pulmonary artery mass.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. taichiro@1997.jukuin.keio.ac.jp

ABSTRACT

Background: Cases of pulmonary artery masses have only rarely been reported, and the optimal type of the diagnosis and treatment is controversial.

Case presentation: An 81-year-old woman was found to have an abnormal shadow on chest X-ray film. Computed tomography showed an irregularly bordered tumor centered in the hilar region extending from segment 6 to the middle lobe of the right lung. Pulmonary angiography showed complete occlusion of the trunk at the periphery proximal to the bifurcation of the posterior ascending branch. Based on bronchoscopic biopsy of the tumor, an adenocarcinoma was diagnosed. Middle and lower lobectomy was performed. Histopathologically, the adenocarcinoma had invaded the tunica intima of the pulmonary artery and also replaced the endothelium in the same region. Although a large thrombus was found at the vessel invasion site of the adenocarcinoma in the pulmonary artery, there were no malignant findings in the thrombus itself.

Conclusions: This is the first reported case of radical resection of a lung cancer with invasion along the pulmonary artery wherein a benign thrombus had formed. In general, surgery would be the treatment of choice for a pulmonary artery mass.

Show MeSH
Related in: MedlinePlus