J Thorac Cardiovasc Surg 2003;126:1247-1250
© 2003 The American Association for Thoracic Surgery
Clinical-pathologic conference |
Clinical-pathologic conference in general thoracic surgery: pulmonary blastoma
Seth Force, MD,
G. Alexander Patterson, MDa,*
a Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo, USA
Received for publication September 19, 2002; accepted for publication October 23, 2002.
* Address for reprints: G. Alexander Patterson, MD, Washington University School of Medicine, Department of Cardiothoracic Surgery, One Barnes Hospital Plaza, Suite 3108 Queeny Tower, St Louis, MO 63110, USA
pattersona@msnotes.wustl.edu
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Case presentation
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Dr Force
A 46-year-old woman initially presented to a local emergency room in February 2002 with shoulder and back pain. She had a chest radiograph that demonstrated an abnormality. A computed tomographic (CT) scan of the chest was performed to characterize this lesion. Her medical history was unremarkable and her surgical history was significant for a basal skin cancer that was removed from her left eyebrow and a left breast lumpectomy for a benign lesion.
Dr Glazer
The chest radiograph is remarkable for a well-defined mass within the left upper lobe, which is well visualized on this CT scan (Figure 1).
It has slightly lobulated borders and it abuts the lateral chest wall with no obvious rib destruction or chest wall invasion. It is relatively homogeneous except for some small low attenuation areas laterally, which may represent areas of necrosis within the mass. There is no calcification and no fat within the mass (Figure 2).
There is a mildly enlarged lymph node in the right hilum, but no other lymphadenopathy seen. No other pulmonary nodules or effusions were seen (Figure 3) and the images in the upper abdomen were normal.
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Figure 1. Preoperative chest radiograph.
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Figure 2. Preoperative chest computed tomography, mediastinal window.
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Figure 3. Preoperative chest CT, lung window.
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Dr Force
The patient subsequently underwent a fine needle aspiration of this lesion at an outside hospital, which revealed a fetal type adenocarcinoma or pulmonary blastoma. She then underwent an extensive radiographic workup that included a CT scan of the abdomen and pelvis, which showed some small hepatic lesions and a large mass in her pelvis that looked like it was coming from the uterus. She had a right upper quadrant ultrasound that showed the liver lesions to be consistent with simple cysts. She also had an MRI of her brain and a PET, which failed . . . [Full Text of this Article]
Copyright © 2003 by The American Association for Thoracic Surgery.
