Patricia Cruz Castellanos

Adenoma pleomórfico pulmonar: A propósito de un caso

We report the case of a 65-year-old man with no significant clinical history who was referred to the respiratory medicine department after a pulmonary nodule was identified during a preoperative workup for a cataract operation. After the initial evaluation, computed tomography (CT) was performed, which revealed several pulmonary lesions: 1 in the right lower lobe (RLL), 1 in the left upper lobe (LUL), and 1 in the left lower lobe (LLL), suggestive of synchronous lung tumors. Positron emission tomography (PETCT) confirmed the presence of pulmonary lesions with increased uptake, indicative of malignancy (Fig. 1). Fiberoptic bronchoscopy was normal. CT-guided fine needle aspiration and biopsy was performed for histological diagnosis, and the pathology report confirmed non-lymphoid adenoid cystic carcinoma with chondroid

Carcinoma microcítico de mama con afectación pulmonar

We report the case of a 58-year-old patient with a significant history of smoking and previous pituitary microadenoma. In August 2014, she consulted due to the appearance of a hard, rapidly growing mass in her right breast detected by self-examination. A screening mammogram 6 months previously had been negative. She underwent mammogram/ultrasound, which showed a dense 18-mm nodule with undefined, spiculated borders in the lower external quadrant, BI-RADS category 5, with no axillary lymphadenopathies. Biopsy of the nodule showed a high-grade neuroendocrine carcinoma with no expression of hormone receptors or HER2 onco-protein, and a cell proliferation index (Ki67) greater than 80%. Given the presence of a rare, highly undifferentiated tumor, we decided to complete the study with imaging tests to rule out distant disease and confirm the mammary origin of the lesion. Computed tomography (CT) confirmed the presence of the breast nodule and showed mediastinal lymphadenopathies in the pathological range (Fig. 1), and multiple millimetric pulmonary nodules, septal thickening, and nodules suggestive of carcinomatous lymphangitis. These findings were confirmed on positron emission tomography, and other disease foci were ruled out. Endobronchial ultrasound was performed, with aspiration of the mediastinal lymphadenopathies, which again showed the presence of a high-grade TTF1-negative neuroendocrine carcinoma with a Ki67 of 98%. In view of the unusual nature of the case, it was discussed in the multidisciplinary session, and the specimens obtained from both sites were compared by the pathology lab. Similar morphology was observed: small and medium-sized cells with minimal cytoplasm, rounded nuclei with glandular chromatin and occasional nucleoli, arranged in the form of solid nests, with no glandular or squamous identification. The immunohistochemical profile showed expression in both cases of cytokeratin 19, synaptophysin, and chromogranin. After review of the various tests and the peculiarity of the case, with the presence of synchronous high-grade neuroendocrine tumors, 2 possible scenarios were considered: the presence of primary lung cancer with secondary breast involvement or a primary breast tumor with lung involvement. The first situation was ruled out when no lung mass was observed in the imaging tests, whereas there was clear evidence of the mammary nodule.

Afectación muscular de un mesotelioma maligno pleural de larga evolución

We report the case of a 60-year-old patient, active smoker (40 pack-years), employed in the construction sector. In 2011, he presented in the emergency room with atypical chest pain. Chest X-ray revealed significant pleural effusion, and he was hospitalized. The study was completed with a computed tomography (CT) of the chest and abdomen, which showed bilateral pleural thickening with significant pleural effusion. Positron emission tomography (PET)-CT confirmed bilateral pleural uptake but ruled out pulmonary nodules and other distant involvement. Tumor disease was suspected, so a pleural biopsy was obtained using videoassisted thoracoscopy, and pleural malignant mesothelioma was confirmed. The extension of the lesion rendered it inoperable, and the patient was referred to medical oncology. Here, we began firstline treatment with a platinum and pemetrexed doublet, and partial response according to RECIST criteria was recorded after 4 cycles, with reduction of the pleural implants and effusion, and low toxicity. Given the clear clinical benefit, treatment continued with single-agent pemetrexed as maintenance therapy with radiological follow-up every 3 months.1 The disease remained stable with optimal oncological control for 2.5 years, when the patient developed pain in the region of the left thigh. Examination revealed increased consistency in the area, which was hard and painful on palpation. A magnetic resonance imaging study performed to rule out a neoplastic process in this region showed a soft tissue lesion involving the whole of the thigh, extending to the gluteus. Radiological characteristics were consistent with secondary involvement (Fig. 1). Given the rarity of the observation, an ultrasound-guided biopsy was performed, confirming metastatic malignant mesothelioma. In view of our patient’s prolonged oligometastatic disease, local radiation therapy to the muscle lesion was proposed. Moreover, because he was clearly benefitting from systemic treatment and in view of the lack of second-line options, he continued the same therapeutic regimen with oncological monitoring for another 12 months. Our case is an example of the clinical and therapeutic management of long-term pleural malignant mesothelioma which raises 2 points of interest: prolonged survival achieved with the treatment, and the presence of secondary musculoskeletal involvement. Malignant mesothelioma is a rare tumor that is characterized by involvement of the serous membranes, most commonly the pleura. It is traditionally associated with exposure to asbestos, although

Ilustramos la dificultad en el diagnóstico y tratamiento del sarcoma pulmonar

A 59-year-old woman with a significant smoking history presented with cough. Chest X-ray revealed a 4 cm pulmonary mass in the left hemithorax. The examination was completed with a positron emission tomography, which confirmed uptake in this region and ruled out secondary involvement (cT2cN0) (Fig. 1); bronchoscopy, which was normal; and computed tomography (CT)-guided fine needle aspiration. Pathology results were indicative of non-small cell lung cancer. In view of these findings, surgery involving left pneumonectomy and hilar-mediastinal lymphadenectomy was planned. Definitive histology results showed a pleomorphic sarcomatoid carcinoma with areas of squamous differentiation. Sarcoma of the lung is an uncommon neoplasm (0.5%–1%). It can be difficult to diagnose since it presents certain similarities to

Tumor fibroso solitario pleural maligno: una rara entidad

apical, anterior and posterior. Bronchoalveolar lavage and cytology were normal. Bronchoalveolar lavage and aspirated fluid were negative for acid-alcohol resistant bacilli and Lowenstein culture for tuberculosis was negative. No clinical or radiological changes were observed after 6 months of follow-up. SI is an uncommon congenital transpositional anomaly in which the organs of the abdomen develop in the wrong place. It occurs at a ratio of men to women of 3:2.3 In the normal arrangement, or situs solitus, the trilobar lung, the liver, the gall bladder and other internal organs are on the right side, but in SI they are on the left. The heart may be on the left on the right.4 In our case, SIT was defined with segmentary atelectasis of the right lung and the development of the right upper lobe in the area of the left upper lobe. To our knowledge, this combination has never been described in the worldwide literature. Sarkar et al.5 are the only authors to have reported a case of unilateral pulmonary hypoplasia associated with abdominal situs inversus in a 2-monthold infant. In conclusion, SI is diagnosed fortuitously during a chest and abdominal imaging study. In these cases, pulmonary atelectasis in the right upper lobe of the left lung may be observed. Conflict of Interests