turkish thoracic society 11 th annual congress
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TURKISH THORACIC SOCIETY 11 th Annual Congress. LUNG AND PLEURAL MALIGNANCIES GRAND ROUND Prof. Metin GORGUNER, MD [email protected]. 23 – 27 April 2008, Antalya, TURKIYE. General Characteristics. Male, 45 years old Born in the Eleşkirt Living in the Ağrı Goverment official - PowerPoint PPT PresentationTRANSCRIPT
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LUNG AND PLEURAL MALIGNANCIESLUNG AND PLEURAL MALIGNANCIES
GRAND ROUNDGRAND ROUND
Prof. Metin GORGUNER, [email protected]
TURKISH THORACIC SOCIETY 11th Annual Congress
23 – 27 April 2008, Antalya, TURKIYE
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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
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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
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Chest X Ray in 29 November 2007
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Thorax CT in 29 November 2007
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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
Patient’s Former History
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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
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A soft, swelling and immobile lesion on the thoracic
wall at the leftside
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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
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What is your initial diagnosis ?
A. Organizing hematoma
B. Chest wall cystic lesion
C. Pleural tumor D. Chest wall tumor E. Rib tuberculosis
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Which test should be performed ?
A. Chest X Ray B. Thorax MRI C. Percutaneous Needle Aspiration D. Bronchoscopy E. Surgery
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Which test should be performed ?
A. Chest X Ray B. Thorax MRI C. Percutaneous Needle Aspiration D. Bronchoscopy E. Surgery
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Chest X Ray
29 November 2007
15 January 2008
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Chest X Ray
29 November 2007
15 January 2008
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Multi Detector CTContrast Enhanced Axial Image
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Multi Detector CTContrast Enhanced Axial Image
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Multi Detector CTContrast Enhanced Axial Image
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Multi Detector CTContrast Enhanced Axial Image
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Multi Detector CTContrast Enhanced Axial Image
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Multi Detector CTContrast Enhanced Axial Image
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Multi Detector CTContrast Enhanced Sagittal Image
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Multi Detector CTContrast Enhanced Sagittal Image
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Multi Detector CTContrast Enhanced Sagittal Image
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Multi Detector CTContrast Enhanced Sagittal Image
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Multi Detector CTContrast Enhanced Coronal Image
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Multi Detector CTContrast Enhanced Coronal Image
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Multi Detector CTContrast Enhanced Coronal Image
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Multi Detector CTContrast Enhanced Coronal Image
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Multi Detector CTMulti-plane Reconstructed Coronal Image
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Multi Detector CTMulti-plane Reconstructed Coronal Image
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Multi Detector CTMulti-plane Reconstructed Coronal Image
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Multi Detector CTMulti-plane Reconstructed Coronal Image
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Multi Detector CT Three Dimensional Volume Rendering Image
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What is your diagnosis ? A. Organizing
hematoma B. Chest wall cystic
lesion C. Malignant
mesothelioma D. Chest wall tumor E. Rib tuberculosis
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Which test should be performed ?
A. Thorax MRI B. Percutaneous Needle Aspiration D. Bronchoscopy C. Pleural Biopsy E. Surgery
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Which test should be performed ?
A. Thorax MRI B. Percutaneous Needle Aspiration D. Bronchoscopy C. Pleural Biopsy E. Surgery
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H.E. – 2x10 Magnification
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H.E. – 20x10 Magnification
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H.E. – 40x10 Magnification
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Vimentin Positive
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cd68 Positive
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ki67 Positive
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Desmin Negative
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s100 Negative
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What is your final diagnosis ?
A. Organizing hematoma
B. Chest wall cystic lesion
C. Malignant mesothelioma
D. Chest wall tumor E. Rib tuberculosis
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What is your final diagnosis ?
A. Organizing hematoma
B. Chest wall cystic lesion
C. Malignant mesothelioma
D. Chest wall tumor E. Rib tuberculosis
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FINAL DIAGNOSIS
Mesenchymal Tumor with Mixoid Component
(Mixoid Malignant Fibrous Histiocytoma)
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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.
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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.
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MALIGNANT FIBROUS HISTIOCYTOMA Pathology
Five histologic subtype; Pleomorphic Mixoid Giant cell Inflammatory Angiomatoid
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MALIGNANT FIBROUS HISTIOCYTOMA Treatment and Prognosis
Surgical resection is recommended if the tumor shows limited extrapulmonary spread to the intrathoracic great vessels or soft tissue.
Adjuvant CT or RT have not proven to be effective.
Mediastinal, chest wall, or carinal involvement, prominent symptoms, incompleteness of excision, and tumor recurrence are the bad prognostic factors.
Survival (2 yrs) approx. 60 %, RR 30 – 60 %
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Jan 1987 – Dec 1995, 13 cases diagnosed as MFH
Only 3 cases with thoracic involvement All of them originated by chest wall One case has lung invasion and
endobronchial tm
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Special thanks to…
Assoc. Prof. Fazli ERDOGAN Department of Pathology
Assoc. Prof. Fatih ALPER Department of Radiology
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Thank you…