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P2.04-047 A Rare Case of Extramedullary Plasmacytoma Occurring in the Posterior Mediastinum
January 2017
(mean age 39) female (60% of cases). Most patient are asymptomatic (50%) although dyspnea, cough, chest pain, hemoptysis can occur. By immunohistochemistry, EHE shows the typical markers of vascular differentiation. Primary epithelioid hemangioendotheliomas of pleura are extremely rare, usually affecting males, and associated with a variety of clinical manifestations and poor prognosis. We present a rare case of EHE with an extensive pleuro-pulmonary involvement. Methods: A 50-year old non-smoking woman presented to our institution complaining of persistent cough and progressive dyspnea first treated with antibiotics without improvement of the symptoms. Chest computed tomography (CT) showed multiple disseminated nodules of both lungs mostly involving the upper lobes with associated right-sided pleural effusion and thickening. There is a elevated serum level of Cancer Antigen (CA) 125. In a right triportal video-assisted thoracoscopy surgery (VATS) we performed wedge resections of the right upper, middle and lower lobes with diffuse nodular process and multiple biopsies of thickened pleura. Results: Pathological examination of the pleuro-pulmonary samples showed multiple, diffuse nodular infiltrates of epithelioid cells with frequent cytoplasmic vacuoles, rare mitoses and foci of tumor necrosis. Immunohistochemistry was positive for Vimentin, CD31, CD34, ETS-related gene (ERG). Therefore, a final diagnosis of Epithelioid hemangioendothelioma was made on the basis of the radiographic, cytomorphologic, and immunohistochemical findings. Conclusion: Pulmonary Epithelioid hemangioendothelioma is a vascular tumor with low to intermediate-grade malignancy. Pleural epithelioid hemangioendothelioma is less common and the clinical behavior is more aggressive and has a poorer prognosis. Our case is an epithelioid hemangioendothelioma with a clinical and pathologic pleuro-pulmonary involvement and a very aggressive clinical course. Keywords: rare vascular neoplasm, endothelial markers, epithelioid hemangioendothelioma, pleuro-pulmonary tumor
P2.04-047 A Rare Case of Extramedullary Plasmacytoma Occurring in the Posterior Mediastinum Topic: Esophageal Cancer and Other Malignancies Rosatea Quercia, Domenico Loizzi, Giulia Pacella, Elvira Spada, Nicoletta Ardò, Fabio Fatone,
Abstracts
S1025
Francesco Sollitto Ospedali Riuniti Di Foggia, Foggia/ Italy Background: Extramedullary plasmacytoma (EMP) is a rare neoplasm that is derived from a monoclonal proliferation of plasma cells in the soft tissues or organs outside the bone marrow and is present in about 3% of all plasma cell neoplasms. The average age of patients is about 60 years. The most frequent site is the upper respiratory tract (approximately 80%). The endotoracic forms usually manifest as nodules or pulmonary masses. Rarely may it present with mediastinal mass as a primitive solitary lesion. We present a case of extramedullary plasmacytoma of the posterior mediastinum. Methods: A 82 years old female presented to us with a history of chest pain, persistent cough, dysphagia, asthenia and dyspnea for few weeks. She denied smoking and had ischemic heart disease and atrial fibrillation as comorbidities. Her serum protein electrophoresis and hemocythometric parameters were normal. Chest X-ray showed a posterior voluminous endothoracic opacity and chest Computed Tomography showed an expansive hypodense lesion of the posterior mediastinum of 15.6 9.1 cm, which surround and displaced the thoracic aorta causing compression of the esophagus and central airways without pathological lesions of the lung parenchyma and the presence of a modest bilateral pleural effusions. Transbronchial needle aspiration under ecoendoscopic guide (EBUS-TBNA) has revealed the presence of isolated elements plasma cell-like (CD138+, lambda chains+). For a precise (correct) histological definition we performed a surgical biopsy of the mediastinal mass through right uniportal videoassisted thoracoscopic surgery (VATS). Results: Pathological examination revealed solid tissue with massive infiltration of elements plasma cell-like. Immunohistochemical analysis showed positive staining for CD138 (plasma cell marker), CD56 (pathological plasma cells marker), monoclonal light chains lambda and negative for CD3 (marker of T line lymphoproliferative diseases). Therefore, a final diagnosis of extramedullary plasmacytoma was made. Conclusion: Our case of EMP without systemic signs of multiple myeloma is extremely rare, especially like a mediastinal mass as a primitive solitary lesion. In terms of posterior mediastinal manifestations of EMP, it should be differentiated from neurogenic tumor, lymphoma, and lymphangioma. 1 EMP could be concurrent with multiple myeloma or the sequences of proceedings for multiple myeloma, the prognosis is very poor and worse than primitive forms. Therefore, precise and timely framing
S1026
(classification) of the disease is essential for diagnostic and therapeutic purposes. Keywords: multiple myeloma, plasma cell marker, extramedullary plasmacytoma, posterior mediastinum neoplasm
P2.04-048 Sarcomatoid Carcinoma of Lung Topic: Esophageal Cancer and Other Malignancies Berna Komurcuoglu,1 Gamze Kaplan,1 Seher Susam,2 Nur Yucel,3 Ahmet Ucvet,4 Enver Yalniz1 1 Pulmonology, Izmir Suat Seren Education Hospitall for Chest Disease, Izmir/Turkey, 2Radiology, Izmir Suat Seren Education Hospitall for Chest Disease, Izmir/Turkey, 3 Pathology, Izmir Suat Seren Education Hospitall for Chest Disease, Izmir/Turkey, 4Thoracic Surgery, Izmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Education Hospital, Izmir/Turkey Background: Sarcomatoid carcinoma of the lung, of all lung cancers are rare tumors that account for about 0.3% to 1%. Moved across the periphery of the lungs tend to show local invasion of adjacent tissues. In the literature, it is more common in older men and other nonsmall cell is reported to have worse prognosis than lung cancer suptip. However, no large studies on this subject. Our hospital patients with a diagnosis of pleomorphic carcinoma within the last five years, radiological and pathological features were analyzed retrospectively. The average age of the patients was 64.9 0 d, 2 patients were women and 16 male patients. The most common symptoms of shortness of breath, weight loss and chest pain. Bronchoscopic biopsy diagnosis in 2 cases, true-cut biopsy in 6 cases, 10 cases were diagnosed by surgical biopsy. Radiological since they tend to settle peripheral lesions and chest wall often been followed showed pleural invasion. The median survival time of the patients was 10.6 months (1 month-24 months). Pleomorphic carcinomas are rare tumors of the clinical literature that lung, radiological and pathological features are not case series highlighting the work we aimed to highlight the features of this rare group. Methods: Retrospective analysis were made in our thoracic oncology clinic datebase. Results: Our hospital patients with a diagnosis of pleomorphic carcinoma within the last five years, radiological and pathological features were analyzed retrospectively. The average age of the patients was 64.9 0 d, 2 patients were women and 16 male patients. The
Journal of Thoracic Oncology
Vol. 12 No. 1S
most common symptoms of shortness of breath, weight loss and chest pain. Bronchoscopic biopsy diagnosis in 2 cases, true-cut biopsy in 6 cases, 10 cases were diagnosed by surgical biopsy. Radiological since they tend to settle peripheral lesions and chest wall often been followed showed pleural invasion. The median survival time of the patients was 10.6 months (1 month-24 months). Conclusion: Pleomorphic carcinomas are rare tumors of the clinical literature that lung, radiological and pathological features are not case series highlighting the work we aimed to highlight the features of this rare group. Keywords: sarcomatoid neoplasms of lung, pleomorphic carcinoma, clinic presentation, prognosis, Prognosis, pleomorphic carcinoma
P2.04-049 Treatment for Three Cases Tracheal Carcinoma of Low-Grade Malignancy Topic: Esophageal Cancer and Other Malignancies Yutaka Oshima, Takashi Suzuki, Mitsutaka Kadokura, Shigeru Yamamoto Thoracic Surgery, Showa University Hospital, Shinagawa,tokyo/ Japan Background: Tracheal carcinoma of low grade malignancy is rare and experience of respiratory doctors on this tumor is limited. Therefore, the diagnostic and therapeutic experiences of doctors need to be discussed at major conferences. Methods: We encountered 3 cases of tracheal carcinoma, two were adenoid cystic carcinoma and one was mucoepidermoid carcinoma. All patients visited the hospital because severe of dyspnea. Results: Case 1. A 40-year-old woman had tracheal adenoid cystic carcinoma at the level of the sternal notch. After intubation using 5-mm tracheal tube, resection of five tracheal rings and reconstruction were completed through a cervical approach. She survived for 12 years postoperatively without recurrence. Case 2. A 44-year-old man with adenoid cystic carcinoma at the mid-trachea underwent resection of eight tracheal rings and reconstruction through midsternotomy. He survived for 14 years postoperatively without recurrence. Case 3. A 79-year-old woman with cardiac pacemaker had a tumor on the right lower tracheal wall extending to the right main bronchus, causing airway compromise due to stenosis. Upon admission, she had middle lobe pneumonia
(mean age 39) female (60% of cases). Most patient are asymptomatic (50%) although dyspnea, cough, chest pain, hemoptysis can occur. By immunohistochemistry, EHE shows the typical markers of vascular differentiation. Primary epithelioid hemangioendotheliomas of pleura are extremely rare, usually affecting males, and associated with a variety of clinical manifestations and poor prognosis. We present a rare case of EHE with an extensive pleuro-pulmonary involvement. Methods: A 50-year old non-smoking woman presented to our institution complaining of persistent cough and progressive dyspnea first treated with antibiotics without improvement of the symptoms. Chest computed tomography (CT) showed multiple disseminated nodules of both lungs mostly involving the upper lobes with associated right-sided pleural effusion and thickening. There is a elevated serum level of Cancer Antigen (CA) 125. In a right triportal video-assisted thoracoscopy surgery (VATS) we performed wedge resections of the right upper, middle and lower lobes with diffuse nodular process and multiple biopsies of thickened pleura. Results: Pathological examination of the pleuro-pulmonary samples showed multiple, diffuse nodular infiltrates of epithelioid cells with frequent cytoplasmic vacuoles, rare mitoses and foci of tumor necrosis. Immunohistochemistry was positive for Vimentin, CD31, CD34, ETS-related gene (ERG). Therefore, a final diagnosis of Epithelioid hemangioendothelioma was made on the basis of the radiographic, cytomorphologic, and immunohistochemical findings. Conclusion: Pulmonary Epithelioid hemangioendothelioma is a vascular tumor with low to intermediate-grade malignancy. Pleural epithelioid hemangioendothelioma is less common and the clinical behavior is more aggressive and has a poorer prognosis. Our case is an epithelioid hemangioendothelioma with a clinical and pathologic pleuro-pulmonary involvement and a very aggressive clinical course. Keywords: rare vascular neoplasm, endothelial markers, epithelioid hemangioendothelioma, pleuro-pulmonary tumor
P2.04-047 A Rare Case of Extramedullary Plasmacytoma Occurring in the Posterior Mediastinum Topic: Esophageal Cancer and Other Malignancies Rosatea Quercia, Domenico Loizzi, Giulia Pacella, Elvira Spada, Nicoletta Ardò, Fabio Fatone,
Abstracts
S1025
Francesco Sollitto Ospedali Riuniti Di Foggia, Foggia/ Italy Background: Extramedullary plasmacytoma (EMP) is a rare neoplasm that is derived from a monoclonal proliferation of plasma cells in the soft tissues or organs outside the bone marrow and is present in about 3% of all plasma cell neoplasms. The average age of patients is about 60 years. The most frequent site is the upper respiratory tract (approximately 80%). The endotoracic forms usually manifest as nodules or pulmonary masses. Rarely may it present with mediastinal mass as a primitive solitary lesion. We present a case of extramedullary plasmacytoma of the posterior mediastinum. Methods: A 82 years old female presented to us with a history of chest pain, persistent cough, dysphagia, asthenia and dyspnea for few weeks. She denied smoking and had ischemic heart disease and atrial fibrillation as comorbidities. Her serum protein electrophoresis and hemocythometric parameters were normal. Chest X-ray showed a posterior voluminous endothoracic opacity and chest Computed Tomography showed an expansive hypodense lesion of the posterior mediastinum of 15.6 9.1 cm, which surround and displaced the thoracic aorta causing compression of the esophagus and central airways without pathological lesions of the lung parenchyma and the presence of a modest bilateral pleural effusions. Transbronchial needle aspiration under ecoendoscopic guide (EBUS-TBNA) has revealed the presence of isolated elements plasma cell-like (CD138+, lambda chains+). For a precise (correct) histological definition we performed a surgical biopsy of the mediastinal mass through right uniportal videoassisted thoracoscopic surgery (VATS). Results: Pathological examination revealed solid tissue with massive infiltration of elements plasma cell-like. Immunohistochemical analysis showed positive staining for CD138 (plasma cell marker), CD56 (pathological plasma cells marker), monoclonal light chains lambda and negative for CD3 (marker of T line lymphoproliferative diseases). Therefore, a final diagnosis of extramedullary plasmacytoma was made. Conclusion: Our case of EMP without systemic signs of multiple myeloma is extremely rare, especially like a mediastinal mass as a primitive solitary lesion. In terms of posterior mediastinal manifestations of EMP, it should be differentiated from neurogenic tumor, lymphoma, and lymphangioma. 1 EMP could be concurrent with multiple myeloma or the sequences of proceedings for multiple myeloma, the prognosis is very poor and worse than primitive forms. Therefore, precise and timely framing
S1026
(classification) of the disease is essential for diagnostic and therapeutic purposes. Keywords: multiple myeloma, plasma cell marker, extramedullary plasmacytoma, posterior mediastinum neoplasm
P2.04-048 Sarcomatoid Carcinoma of Lung Topic: Esophageal Cancer and Other Malignancies Berna Komurcuoglu,1 Gamze Kaplan,1 Seher Susam,2 Nur Yucel,3 Ahmet Ucvet,4 Enver Yalniz1 1 Pulmonology, Izmir Suat Seren Education Hospitall for Chest Disease, Izmir/Turkey, 2Radiology, Izmir Suat Seren Education Hospitall for Chest Disease, Izmir/Turkey, 3 Pathology, Izmir Suat Seren Education Hospitall for Chest Disease, Izmir/Turkey, 4Thoracic Surgery, Izmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Education Hospital, Izmir/Turkey Background: Sarcomatoid carcinoma of the lung, of all lung cancers are rare tumors that account for about 0.3% to 1%. Moved across the periphery of the lungs tend to show local invasion of adjacent tissues. In the literature, it is more common in older men and other nonsmall cell is reported to have worse prognosis than lung cancer suptip. However, no large studies on this subject. Our hospital patients with a diagnosis of pleomorphic carcinoma within the last five years, radiological and pathological features were analyzed retrospectively. The average age of the patients was 64.9 0 d, 2 patients were women and 16 male patients. The most common symptoms of shortness of breath, weight loss and chest pain. Bronchoscopic biopsy diagnosis in 2 cases, true-cut biopsy in 6 cases, 10 cases were diagnosed by surgical biopsy. Radiological since they tend to settle peripheral lesions and chest wall often been followed showed pleural invasion. The median survival time of the patients was 10.6 months (1 month-24 months). Pleomorphic carcinomas are rare tumors of the clinical literature that lung, radiological and pathological features are not case series highlighting the work we aimed to highlight the features of this rare group. Methods: Retrospective analysis were made in our thoracic oncology clinic datebase. Results: Our hospital patients with a diagnosis of pleomorphic carcinoma within the last five years, radiological and pathological features were analyzed retrospectively. The average age of the patients was 64.9 0 d, 2 patients were women and 16 male patients. The
Journal of Thoracic Oncology
Vol. 12 No. 1S
most common symptoms of shortness of breath, weight loss and chest pain. Bronchoscopic biopsy diagnosis in 2 cases, true-cut biopsy in 6 cases, 10 cases were diagnosed by surgical biopsy. Radiological since they tend to settle peripheral lesions and chest wall often been followed showed pleural invasion. The median survival time of the patients was 10.6 months (1 month-24 months). Conclusion: Pleomorphic carcinomas are rare tumors of the clinical literature that lung, radiological and pathological features are not case series highlighting the work we aimed to highlight the features of this rare group. Keywords: sarcomatoid neoplasms of lung, pleomorphic carcinoma, clinic presentation, prognosis, Prognosis, pleomorphic carcinoma
P2.04-049 Treatment for Three Cases Tracheal Carcinoma of Low-Grade Malignancy Topic: Esophageal Cancer and Other Malignancies Yutaka Oshima, Takashi Suzuki, Mitsutaka Kadokura, Shigeru Yamamoto Thoracic Surgery, Showa University Hospital, Shinagawa,tokyo/ Japan Background: Tracheal carcinoma of low grade malignancy is rare and experience of respiratory doctors on this tumor is limited. Therefore, the diagnostic and therapeutic experiences of doctors need to be discussed at major conferences. Methods: We encountered 3 cases of tracheal carcinoma, two were adenoid cystic carcinoma and one was mucoepidermoid carcinoma. All patients visited the hospital because severe of dyspnea. Results: Case 1. A 40-year-old woman had tracheal adenoid cystic carcinoma at the level of the sternal notch. After intubation using 5-mm tracheal tube, resection of five tracheal rings and reconstruction were completed through a cervical approach. She survived for 12 years postoperatively without recurrence. Case 2. A 44-year-old man with adenoid cystic carcinoma at the mid-trachea underwent resection of eight tracheal rings and reconstruction through midsternotomy. He survived for 14 years postoperatively without recurrence. Case 3. A 79-year-old woman with cardiac pacemaker had a tumor on the right lower tracheal wall extending to the right main bronchus, causing airway compromise due to stenosis. Upon admission, she had middle lobe pneumonia