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A case of lung carcinoma with rhabdoid phenotype mimicking an aspergilloma in patient with recurrent hemoptysis.

Kim MW, Rew SJ, Eun SJ, Lee US, Park CW, Jeong JP, Ko YC - Tuberc Respir Dis (Seoul) (2014)

Bottom Line: An aspergilloma was diagnosed by the radiologist.However, after surgical excision and pathological examination, rhabdoid carcinoma was diagnosed.A surgical resection helps to make it possible to pathologically distinguish a malignancy from an aspergilloma.

View Article: PubMed Central - PubMed

Affiliation: Division of Tuberculosis and Pulmonology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea.

ABSTRACT
Malignant rhabdoid tumor was first discovered in the kidney, and rhabdoid tumor of the lung was first reported in 1995. These were included as the variants of large-cell carcinoma, according to the 1999 World Health Organization classification of lung tumors. The rhabdoid tumor of the lung exhibits aggressive biological behavior and has a poor prognosis, and only a few reports of this tumor exist. We report a case of lung carcinoma with a rhabdoid phenotype, initially misdiagnosed as an aspergilloma, in a 48-year-old man who presented with recurrent hemoptysis. The chest computed tomography scans showed a huge consolidative lesion with an air crescent sign in the left upper lung and no contrast-enhancing lesion. An aspergilloma was diagnosed by the radiologist. However, after surgical excision and pathological examination, rhabdoid carcinoma was diagnosed. A surgical resection helps to make it possible to pathologically distinguish a malignancy from an aspergilloma.

No MeSH data available.


Related in: MedlinePlus

(A) The patient underwent surgical operation of the left upper lobectomy and decortication. (B) There was a 20×12×8-cm-sized mass containing 8×7-cm-sized cavitary lesion with extensive central necrosis.
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Figure 2: (A) The patient underwent surgical operation of the left upper lobectomy and decortication. (B) There was a 20×12×8-cm-sized mass containing 8×7-cm-sized cavitary lesion with extensive central necrosis.

Mentions: A 48-year-old male visited our hospital, complaining of recurrent abundant hemoptysis for 2 months. He was a smoker with a 40 pack-year smoking history and had been taking medications for diabetes for 5 years. He did not have a family history of malignancy or immunosuppressive disease. He had a history of pulmonary tuberculosis 3 years ago and had taken an anti-tuberculosis medication for 6 months. On admission, he presented with a blood pressure of 110/70 mm Hg, a heart rate of 80 beats per minute, a respiratory rate of 20 breaths per minute, and a body temperature of 36.8℃. Physical examination of the chest revealed crackles in both lungs. Lymph nodes in the neck could not be palpated. The complete blood count showed a white blood cell count of 14,200/mm3 (neutrophils, 78.4%; lymphocytes, 16.2%; monocytes, 5.1%; and eosinophils, 0.2%), hemoglobin level of 7.0 g/dL and platelet count of 665,000/mm3. Routine blood chemistry and tumor markers were within normal limits except for C-reactive protein, which was 15.5 mg/dL. Chest X-ray and computed tomography (CT) scans of the chest revealed a consolidative lesion, which had high internal attenuation with bubble lucency, and a solid mass of the left upper lung (Figure 1B). Also there was a round mass with soft-tissue opacity within a lung cavity of the right upper lung. In the left upper lung, the mass was separated from the wall of the cavity by an airspace of variable shape and size indicative of an "air crescent" sign, and there was no contrast-enhancement (Figure 1A). There was no evidence of mediastinal or hilar lymphadenopathy elsewhere radiologically. The clinical diagnosis was a fungal ball with hematoma. The patient underwent bronchial artery embolization twice for persistent hemoptysis. After this, fiberoptic bronchoscopy for pre-operation evaluation of the exact site of bleeding was planned. Fiberoptic bronchoscopy showed that some blood clots with active bleeding were present in the left upper lobe apicoposterior segment (especially in the posterior subsegment). Because of the uncontrolled hemoptysis, the patient underwent left upper lobectomy and decortication. Video-assisted thoracoscopic surgery showed that there was a 20×12×8-cm-sized mass (Figure 2A) and a 8×7-cm-sized cavitary lesion in the left upper lobe (Figure 2B).


A case of lung carcinoma with rhabdoid phenotype mimicking an aspergilloma in patient with recurrent hemoptysis.

Kim MW, Rew SJ, Eun SJ, Lee US, Park CW, Jeong JP, Ko YC - Tuberc Respir Dis (Seoul) (2014)

(A) The patient underwent surgical operation of the left upper lobectomy and decortication. (B) There was a 20×12×8-cm-sized mass containing 8×7-cm-sized cavitary lesion with extensive central necrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127412&req=5

Figure 2: (A) The patient underwent surgical operation of the left upper lobectomy and decortication. (B) There was a 20×12×8-cm-sized mass containing 8×7-cm-sized cavitary lesion with extensive central necrosis.
Mentions: A 48-year-old male visited our hospital, complaining of recurrent abundant hemoptysis for 2 months. He was a smoker with a 40 pack-year smoking history and had been taking medications for diabetes for 5 years. He did not have a family history of malignancy or immunosuppressive disease. He had a history of pulmonary tuberculosis 3 years ago and had taken an anti-tuberculosis medication for 6 months. On admission, he presented with a blood pressure of 110/70 mm Hg, a heart rate of 80 beats per minute, a respiratory rate of 20 breaths per minute, and a body temperature of 36.8℃. Physical examination of the chest revealed crackles in both lungs. Lymph nodes in the neck could not be palpated. The complete blood count showed a white blood cell count of 14,200/mm3 (neutrophils, 78.4%; lymphocytes, 16.2%; monocytes, 5.1%; and eosinophils, 0.2%), hemoglobin level of 7.0 g/dL and platelet count of 665,000/mm3. Routine blood chemistry and tumor markers were within normal limits except for C-reactive protein, which was 15.5 mg/dL. Chest X-ray and computed tomography (CT) scans of the chest revealed a consolidative lesion, which had high internal attenuation with bubble lucency, and a solid mass of the left upper lung (Figure 1B). Also there was a round mass with soft-tissue opacity within a lung cavity of the right upper lung. In the left upper lung, the mass was separated from the wall of the cavity by an airspace of variable shape and size indicative of an "air crescent" sign, and there was no contrast-enhancement (Figure 1A). There was no evidence of mediastinal or hilar lymphadenopathy elsewhere radiologically. The clinical diagnosis was a fungal ball with hematoma. The patient underwent bronchial artery embolization twice for persistent hemoptysis. After this, fiberoptic bronchoscopy for pre-operation evaluation of the exact site of bleeding was planned. Fiberoptic bronchoscopy showed that some blood clots with active bleeding were present in the left upper lobe apicoposterior segment (especially in the posterior subsegment). Because of the uncontrolled hemoptysis, the patient underwent left upper lobectomy and decortication. Video-assisted thoracoscopic surgery showed that there was a 20×12×8-cm-sized mass (Figure 2A) and a 8×7-cm-sized cavitary lesion in the left upper lobe (Figure 2B).

Bottom Line: An aspergilloma was diagnosed by the radiologist.However, after surgical excision and pathological examination, rhabdoid carcinoma was diagnosed.A surgical resection helps to make it possible to pathologically distinguish a malignancy from an aspergilloma.

View Article: PubMed Central - PubMed

Affiliation: Division of Tuberculosis and Pulmonology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea.

ABSTRACT
Malignant rhabdoid tumor was first discovered in the kidney, and rhabdoid tumor of the lung was first reported in 1995. These were included as the variants of large-cell carcinoma, according to the 1999 World Health Organization classification of lung tumors. The rhabdoid tumor of the lung exhibits aggressive biological behavior and has a poor prognosis, and only a few reports of this tumor exist. We report a case of lung carcinoma with a rhabdoid phenotype, initially misdiagnosed as an aspergilloma, in a 48-year-old man who presented with recurrent hemoptysis. The chest computed tomography scans showed a huge consolidative lesion with an air crescent sign in the left upper lung and no contrast-enhancing lesion. An aspergilloma was diagnosed by the radiologist. However, after surgical excision and pathological examination, rhabdoid carcinoma was diagnosed. A surgical resection helps to make it possible to pathologically distinguish a malignancy from an aspergilloma.

No MeSH data available.


Related in: MedlinePlus