Psammoma bodies in pleural fluid associated with a mesothelioma: case report.
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Various clinical and pathological features of Hodgkin's disease and its related disorders are discussed: a rare, benign form of Hodgkin's disease with skin loci only; unusual primary sites (bone, spleen, lungs and intestine---including alphs-chain disease): various paraneplastic syndromes caused by hyperparathyroidism and hypercorticism; idiopathic nephrotic syndromes of immunological origin. Reference is also made to possible relationships between lymphoma and leukaemia.
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A surgically confirmed primary angiosarcoma of the chest wall is described. CT showed a right chest wall mass projecting into the thoracic cavity from the right axilla. The tumor was a high density, inhomogeneous-density mass. Invasion to the rib was noted, and calcified foci were demonstrated. A homogenous high-density mass ventral to the chest wall mass was shown. Contrast-enhanced CT did not demonstrate any enhancement. MRI demonstrated a large heterogeneous mass on both T1-weighted images (T1WI) and T2-weighted images (T2WI). Contrast-enhanced axial T1-weighted MR images did not show any enhancement of the mass, but the homogenous mass ventral to the chest wall mass was shown. MRI demonstrated certain characteristic findings of angiosarcoma of the chest wall. Intratumoral hemorrhage with juxtaposed hematoma and aggressive invasion to the surrounding tissue suggest angiosarcoma.
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Out of 440 pleural biopsies done with Abrams or Castelain needle, performed over 11 years in 300 pleural effusions, only 14 incidents of accidents occurred. There were 9 minor ones (intrapleural bleeding, subcutaneous emphysema, pneumoserosa by aspiration). Neoplastic graft along the biopsy tract was observed in 5 cases, of which 4 were primitive malignant mesotheliomas and one a primitive appearing neoplastic pleurisy. The risk of parietal neoplastic seeding runs high in malignant mesothelioma, considering that 11 such cases were included in this series of biopsied patients. This risk is not specific to plaural biopsy and can be encountered in simple thoracentesis. This complication therefore is not a contra-indication to needle biopsy as it is only observed in diseases beyond surgical redemption.
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The aim of the study was to study efficiency of diagnosis and surgical treatment of intrathoracic neurogenic tumors. Since 1990 to 2002, 28 patients with neurogenic tumors underwent surgical treatment in National Cancer Center and various clinics of Tbilisi. Age of the patients ranged from 14 to 65 years. The tumors located in the mediastinum in 20 patients, in the chest wall with intrathoracic growth--6 patients, and in the lung--2 patients. Radiology (X-ray, CT), endoscopy and cytology were used for diagnosis. It was demonstrated that CT, CT-guided fine-needle biopsy and videothoracoscopy improve diagnosis of intrathoracic neurogenic tumors. Radical surgery is the method of choice in surgical treatment of intrathoracic neurogenic tumors.
Chest wall lesions in childhood include a wide range of pathologies. Benign lesions include lipoma, neurofibroma, lymphangioma, haemangioma and mesenchymal hamartoma. Malignant lesions include neuroblastoma, rhabdomyosarcoma, Ewings sarcoma, Askin tumour and primitive neuroectodermal tumours. Manifestations of systemic diseases such as leukaemia, lymphoma, Langerhans cell histocytosis and infections such as tuberculosis and actinomycosis may also cause chest wall lesions. The imaging characteristics of the above are reviewed but only a minority of lesions show diagnostic imaging characteristics. Most lesions require biopsy and histopathological examination for definitive diagnosis. The role of different imaging modalities is discussed, with an emphasis on magnetic resonance imaging for demonstrating lesion morphology and local spread, with computed tomography and nuclear medicine being used mainly to assess remote disease.
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A 43-year-old-woman who had sever anterior chest pain visited our hospital on April 3, 2000. A well-defined abnormal shadow was seen in the middle and lower field of the right lung on chest X-ray. Computed tomography showed a large fat density mass in the right pleural cavity with a septum enhanced by contrast medium. Percutaneous needle biopsy revealed lipoma or liposarcoma. Complete resection could be done with combined resection of right lung, lpericardium, parietal pleura and diaphragm. Final histologic diagnosis was well differentiated liposarcoma. There are few reports of liposarcoma arising in the thoracic cavity, we present our case and review the 23 cases reported from the Japanese literatures.
We report a 74-year-old woman with malignant fibrous histiocytoma (MFH), treated successfully by radiation and followed with chest wall resection and reconstruction. The patient suffered from right back pain and her chest X-ray showed a clear round shadow in the middle field of the right lung. Chest computed tomography (CT) showed a 5 x 5 cm tumor in diameter, involving the right 8 rib with destructive changes. After radiation therapy of total 30 Gy to the tumor to obtain the safety surgical margin, we widely resected 10 x 9 cm chest wall with 3 ribs in area under thoracoscopy and performed reconstruction using GORE-TEX Soft Tissue Patch. The pathological and immuno-histochemical diagnosis showed pleomorphic type of MFH. Final result of the tumor negative in surgical margin manifested that our technique of chest wall resection and reconstruction using thoracoscope after the irradiation to the tumor was very safe and useful.
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