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  P1.09 - Pathology (Not CME Accredited Session) (ID 941)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall

  • 26544

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    P1.09-40 - Metastatic Endometrial Sarcoma Presenting as a Spontaneous Pneumothorax and Masquerading as a Pulmonary Blastoma. (ID 14400)

    16:45 - 18:00  |  Author(s): Rahim Wooley
    • Abstract

    Background
    

    For the proper evaluation of pulmonary cavitary lesions, it is essential to obtain an adequate assessment of the patient’s clinical history. Imaging studies can be equivocal and adequate pathological diagnosis can also be challenging. This is particularly important in the case of metastatic lung tumors with extra-thoracic origin, such as certain gynecologic malignancies, which—owing to their late metastatic potential—can be noted years after removal of the primary tumor, causing a misdiagnosis.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We illustrate this scenario with an interesting case of an endometrial stromal sarcoma which presented as a cavitary lesion causing a spontaneous pneumothorax and initially diagnosed as a pulmonary blastoma.

    4c3880bb027f159e801041b1021e88e8 Result
    

    44 year old woman presented with a one day history of left sided chest pain and shortness of breath. The pain was sudden, sharp and associated with dyspnea. The patient denied any fevers, chills, cough, hemoptysis, weight loss, recent travel, sick contacts or tuberculosis. A chest X-ray demonstrated a large left-sided pneumothorax and a chest CT showed a left upper lobe cavitary lesion (Figure 1). Subsequently, a left upper lobe and lingual wedge resection were performe and biopsies of the cavitary lesion were sent. The initial pathological impression was that this was a pulmonary blastoma with heterologous leiomyosarcomatous differentiation. However, further history revealed that the patient had chronic anemia and menometrorrhagia secondary to uterine fibromas and had a total abdominal hysterectomy one year prior to presentation. This finding prompted a review of the pathological specimen and positive immunoreactivity to estrogen/progesterone receptors (ER+/PR+), and CD10+ provided the alternate diagnosis of a metastatic low-grade stromal sarcoma of endometrial origin. Patient followed with medical oncology and gynecology and is currently undergoing hormonal therapy.

    

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    This case highlights the importance of a proper correlation of clinical history alongside imaging studies and immunohistochemical findings in the diagnosis of certain lung lesions, in particular thoracic gynecological malignancies.

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