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Primary Pulmonary Sarcoma. Wael Batobara. History. 78y Caucasian Male presented to ER 9 days SOBE , Dry Cough , Night Sweating X smoker >50 y ( 10 pack y ) Received 3 days Levofluxacin for ? CAP No Chest pain , Hemoptysis , Orthopnea or PND No Leg swelling No Change in Wt or appetite.

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Presentation Transcript
history
History
  • 78y Caucasian Male presented to ER

9 days SOBE , Dry Cough , Night Sweating

  • X smoker >50 y ( 10 pack y )
  • Received 3 days Levofluxacin for ? CAP
  • No Chest pain , Hemoptysis , Orthopnea or PND
  • No Leg swelling
  • No Change in Wt or appetite
history1
History
  • PMH : GERD , BPH & Knee OA
  • No contact with similar case
  • No recent travel
  • No pets or occupational exposure
  • NKA
  • Rx : PRN NSAID , H2 Blocker
examination
Examination
  • Afebrile BP 150/90 HR 100 regular
  • RR 20 Sat 93% on 5 liters O2
  • No Pallor or Lymphadenopathy
  • Chest: Central Trachea

Dull percussion Lt Lower 2/3 Post

Absent breath sound Lt L 2/3 post

  • CVS ,Abd & LL NAD
investigation
Investigation
  • CBC WBC & Plt  N

HB 130 MCV N

  • PTT & INR  N
  • Lytes ,BUN & Creat  N
  • LFT , EKG & UA  N
  • ABG PH 7.38 PO2 75 3L O2

PCo2 35 HCO3 26

  • CXR & Chest CT
investigation1
Investigation
  • Pleural Tapping  2.8 liters drained

Serosanguinus

exudate

-ve cytology

  • CT Guided Bx  Spindle Cell Sarcoma
  • CT Head , Abd & Pelvis N
hospital course
Hospital Course
  • Seen By Thoracic Sx  Inoperable
  • Seen By Med.Onc.offered Chemo & XRT
  • Post tap CXR small effusion

Not accessible By US

  • Improved SOB Sat 94% RA
  • Discharged Home
  • F/U Oncology clinic for XRT +/- Chemo
primary lung sarcoma
Primary Lung Sarcoma
  • Incidence
  • Presenting Symptoms & Signs
  • Diagnosis
  • Treatment
  • Prognostic Factors
incidence
Incidence
  • Sarcomas are rare malignant tumors arising from the mesenchymal tissues at all body sites and include a wide array of histopathologic types
  • 10,700 newly diagnosed sarcomas per year in the United States {0.80 percent of the 1,334,100 new malignant tumors }
  • 77 percent arise in soft tissue and the remainder in bone

CA Cancer J Clin 2003 Jan-Feb

incidence1
Incidence
  • Primary Lung Sarcoma is Rare { 0.1-1% of all lung cancers}
  • From 1970 To 1999

In Hospital Louis Pardel 12 Cases

Lung Cancer 38-2002

  • From 1982 To1998

In Lille University Hospital  18 Cases

Euro Jr Of Cardiothoracic Sx 18-2000

patients characteristics
Patients Characteristics
  • Male 7/12 Vs 7/18
  • Female 5/12 Vs 11/18
  • Mean age 50 Vs 53
  • Smoking 7/12 Vs 8/18
  • Asymptomatic 1/12 Vs 9/18

Lung Cancer 38-2002 Vs Euro Jr Of Cardiothoracic Sx 18-2000

symptoms signs
Symptoms & Signs
  • Chest pain ,SOB & Cough common
  • Fatigue , Wt loss less common
  • Supraclavicular LN & Pancoast Syn in 1 Pt
  • CXR & CT  Solitary masses

Upper Lobe

other features : cavitations ,effusions ,atelectasis

,chest wall & ribs involvements

Lung Cancer 38-2002 & Euro Jr Of Cardiothoracic Sx 18-2000

bronchoscopy pathology
Bronchoscopy & Pathology
  • N 8/12 Vs 8/18
  • Endobronchial lesion 1/12 Vs 7/18
  • Extrinsic compression 3/12 Vs 3/18
  • Most common type Leiomyosarcoma 7/12

then monophasic synovial sarcoma 2/12

  • While in the other study

Malignant Fibrous Histiocytoma 4/18

Undifferentiated Sarcoma 4/18

Lung Cancer 38-2002 & Euro Jr Of Cardiothoracic Sx 18-2000

diagnosis
Diagnosis
  • PET Scan
  • 18 Patients with soft tissue sarcoma

4 Patients with benign soft tissue lesion

  • 100% sensitivity for sarcoma
  • Uptake correlate with tumor grade
  • Only one benign lesion showed uptake

Journal of Nuclear Medicine Feb 1996

treatment prognosis
Treatment & Prognosis
  • 9/12 Surgery 6 lobectomies

& 3 pneumonectomies

  • 3/12 Inoperable : 1 Pancoast , 1 Age

1 locally advanced disease

  • 3/12 Chemotherapy Ifosamiade containing regimens IVA or IVAD

CA Cancer J Clin 2003 Jan-Feb

treatment prognosis1
Treatment & Prognosis
  • 6/12 alive disease free
  • 6/12 died 4 from disease progression
  • 1,3,5 y Survival was 71,50,38 %
  • Relapse 5/12 4 intrathoracic Rx wit Chemo

CA Cancer J Clin 2003 Jan-Feb

treatment prognosis2
Treatment & Prognosis
  • 15/18 Surgery
  • 3/18 pre op Chemo to shrink tumor size

 successful in 2 patients

1 free resection margins

1 microscopic invasion

Euro Jr Of Cardiothoracic Sx 18-2000

treatment prognosis3
Treatment & Prognosis
  • 9/18 died 5 from sarcoma
  • 9/18 alive till now 3 with recurrent disease which was resected in 2
  • Significant correlation between stage & survival
  • 5 y survival 43%

Euro Jr Of Cardiothoracic Sx 18-2000

thank you

Thank You

I hope It Was Not Boring