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TURKISH THORACIC SOCIETY 11 th Annual Congress

TURKISH THORACIC SOCIETY 11 th Annual Congress. LUNG AND PLEURAL MALIGNANCIES GRAND ROUND Prof. Metin GORGUNER, MD gorguner@atauni.edu.tr. 23 – 27 April 2008, Antalya, TURKIYE. General Characteristics. Male, 45 years old Born in the Eleşkirt Living in the Ağrı Goverment official

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TURKISH THORACIC SOCIETY 11 th Annual Congress

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  1. TURKISH THORACIC SOCIETY 11th Annual Congress LUNG AND PLEURAL MALIGNANCIES GRAND ROUND Prof. Metin GORGUNER, MD gorguner@atauni.edu.tr 23 – 27 April 2008, Antalya, TURKIYE

  2. General Characteristics • Male, 45 years old • Born in the Eleşkirt • Living in the Ağrı • Goverment official • Back pain at left hemithorax • Admission; 14 Jan 2008

  3. Patient’s Brief History • Back pain at left side during the last 2 months • Various nonspesific therapies • Pain relieving with analgesics Chest X Ray in Nov 2007 Thorax CT in Nov 2007

  4. Chest X Ray in 29 November 2007

  5. Thorax CT in 29 November 2007

  6. Patient’s Former History • Pneumonia in 1985 ? • Traffic accident in 1990 • Discal hernia operation in 2000 • Varicose veins of the left leg • Pantoprazol, 40 mg/daily • Smoking, 25 packs-year • No history of familial disease

  7. Physical Examination • Good performance status • A soft, swelling and immobile lesion on the thoracic wall at the leftside • In percussion; dullness of left lower hemithorax • In auscultation; diminished breath sounds of left lower hemithorax

  8. A soft, swelling and immobile lesion on the thoracic wall at the leftside

  9. Laboratory Findings • All of the parameters was normal • except the ESR: 80 mm/hour • Tuberculin skin test was negative • Electrocardigraphy was normal • Mild restriction on PFT

  10. What is your initial diagnosis ? A. Organizing hematoma B. Chest wall cystic lesion C. Pleural tumor D. Chest wall tumor E. Rib tuberculosis

  11. Which test should be performed ? A. Chest X Ray B. Thorax MRI C. Percutaneous Needle Aspiration D. Bronchoscopy E. Surgery

  12. Which test should be performed ? A. Chest X Ray B. Thorax MRI C. Percutaneous Needle Aspiration D. Bronchoscopy E. Surgery

  13. Chest X Ray 29 November 2007 15 January 2008

  14. Chest X Ray 29 November 2007 15 January 2008

  15. Multi Detector CTContrast Enhanced Axial Image

  16. Multi Detector CTContrast Enhanced Axial Image

  17. Multi Detector CTContrast Enhanced Axial Image

  18. Multi Detector CTContrast Enhanced Axial Image

  19. Multi Detector CTContrast Enhanced Axial Image

  20. Multi Detector CTContrast Enhanced Axial Image

  21. Multi Detector CTContrast Enhanced Sagittal Image

  22. Multi Detector CTContrast Enhanced Sagittal Image

  23. Multi Detector CTContrast Enhanced Sagittal Image

  24. Multi Detector CTContrast Enhanced Sagittal Image

  25. Multi Detector CTContrast Enhanced Coronal Image

  26. Multi Detector CTContrast Enhanced Coronal Image

  27. Multi Detector CTContrast Enhanced Coronal Image

  28. Multi Detector CTContrast Enhanced Coronal Image

  29. Multi Detector CTMulti-plane Reconstructed Coronal Image

  30. Multi Detector CTMulti-plane Reconstructed Coronal Image

  31. Multi Detector CTMulti-plane Reconstructed Coronal Image

  32. Multi Detector CTMulti-plane Reconstructed Coronal Image

  33. Multi Detector CTThree Dimensional Volume Rendering Image

  34. What is your diagnosis ? A. Organizing hematoma B. Chest wall cystic lesion C. Malignant mesothelioma D. Chest wall tumor E. Rib tuberculosis

  35. Which test should be performed ? A. Thorax MRI B. Percutaneous Needle Aspiration D. Bronchoscopy C. Pleural Biopsy E. Surgery

  36. Which test should be performed ? A. Thorax MRI B. Percutaneous Needle Aspiration D. Bronchoscopy C. Pleural Biopsy E. Surgery

  37. H.E. – 2x10 Magnification

  38. H.E. – 20x10 Magnification

  39. H.E. – 40x10 Magnification

  40. Vimentin Positive

  41. cd68 Positive

  42. ki67 Positive

  43. Desmin Negative

  44. s100 Negative

  45. What is your final diagnosis ? A. Organizing hematoma B. Chest wall cystic lesion C. Malignant mesothelioma D. Chest wall tumor E. Rib tuberculosis

  46. What is your final diagnosis ? A. Organizing hematoma B. Chest wall cystic lesion C. Malignant mesothelioma D. Chest wall tumor E. Rib tuberculosis

  47. FINAL DIAGNOSIS Mesenchymal Tumor with Mixoid Component (Mixoid Malignant Fibrous Histiocytoma)

  48. MALIGNANT FIBROUS HISTIOCYTOMA Clinical Summary – 1 • A common soft tissue tumor • In late middle age, with a median of 54 yrs • Develops frequently in the extremities and the retroperitoneum. • The lungs are the most common site of metastases. • Primary pulmonary MFH is extremely rare.

  49. MALIGNANT FIBROUS HISTIOCYTOMA Clinical Summary – 2 • Clinical and radiographic features are nonspesific; • Cough, chest pain, hemoptysis, dyspnea • A solitary mass with a nondescript appearance and relatively homogeneous density on CT or MR • Tissue examination is absolutely required.

  50. MALIGNANT FIBROUS HISTIOCYTOMA Pathology • Five histologic subtype; • Pleomorphic • Mixoid • Giant cell • Inflammatory • Angiomatoid

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