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Elena Maiolino



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    P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.14-10 - Surgical Treatment of a Rare Case of Clear Cell Carcinomatous Transformation of a Diaphragmatic Endometriosis Focus (ID 14303)

      16:45 - 18:00  |  Author(s): Elena Maiolino

      • Abstract
      • Slides

      Background

      Thoracic endometriosis is an ectopic, unusual localization of endometrial tissue in endothoracic organs. The development of thoracic endometriosis can be determined by the embolization of endometriotic foci to the lung by lymphatic, hematic or trans-diaphragmatic way. We report a rare case of carcinomatous transformation of a diaphragmatic endometriosis focus, successfully treated with surgery.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A 46-year old woman, with a history of previous operation for bilateral endometriotic pelvic cyst, presented to our institution with dyspnoea and massive right pleural effusion, which was treated with chest drainage. After drainage, chest and abdomen computerized tomography (CT) and magnetic resonance imaging (MRI) showed a large (7 x 6 cm), roundish, inhomogeneous, capsulated mass of the right hemidiaphragm, causing compression of the adjacent lung and liver. Fiberbronchoscopy showed an extrinsic compression of subsegmental bronchi of the basal pyramid of the right lung. After cardio-respiratory function evaluation, the patient underwent videothoracoscopic pleural biopsies with frozen section negative for malignancy, therefore we converted in antero-lateral thoracotomy and a radical surgical resection of the diaphragmatic mass, en-bloc with the adherent and apparently infiltrated lung and hepatic parenchyma, was performed.

      4c3880bb027f159e801041b1021e88e8 Result

      Postoperative course was uneventful. Histopathology revealed a clear cell carcinoma deriving from a malignant transformation of an ectopic diaphragmatic endometriosis focus; Ki67 was > 50%; PI3KCA and BRAF genes were not mutated. Total body 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT showed bilateral increased ovarian uptake, thus the patient underwent radical abdominal hysterectomy, with diagnosis of endometriosis, and subsequent adjuvant chemotherapy for the diaphragmatic clear cell carcinoma. Total body CT scan at 7 months from surgery shows neither local recurrence, nor distant metastases.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Thoracic endometriosis requires a multidiciplinary approach and management. In our experience, surgery represented the treatment of choice, in order to ensure oncological radicality, in a young patient with a rare condition of carcinomatous transformation of a diaphragmatic endometriosis focus, which should be considered among the possible evolutions of endometriosis. To the best of our knowledge, this is the first reported case of radical surgical treatment of a clear cell carcinomatous transformation of a diaphragmatic endometriosis focus.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.CR-27 - Surgical Treatment of a Rare Case of Mediastinal Masson's Tumor Mimicking a Thymoma (ID 13988)

      12:00 - 13:30  |  Author(s): Elena Maiolino

      • Abstract
      • Slides

      Background

      Masson's tumor or intravascular papillary endothelial hyperplasia (IPEH) is a rare non-malignant pseudotumoral disease, characterized by an exuberant endothelial proliferation usually arising as a reactive process within a normal blood vessel. The pathogenesis of intravascular papillary endothelial hyperplasia is still unclear, but it seems that the exuberant tissue derives from an autocrine stimulation of the endothelial cells due to the secretion of basic Fibroblast Growth Factor (bFGF). There are three types of papillary endothelial hyperplasia: primary or intravascular form, secondary or mixed form and tertiary or extravascular (rarer) form. Mediastinal localization is exceptional. We report a rare case of antero-superior mediastinal Masson's tumor mimicking a thymoma, successfully treated with surgery.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A 48-year old man presented to our institution with computerized tomography (CT) evidence of a 4 x 3 cm antero-superior mediastinal mass, extending up to the right thyroid lobe, resembling a thymoma. Total body 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT revealed a SUV max of 3.5. Despite complaining of a myastheniform syndrome (asthenia and slight palpebral ptosis) laboratory (anti-MUsk and anti-AChR antibodies) and instrumental evaluation (electromyography) were found to be normal. The patient had previously undergone resection of a right supraclavicular Masson's tumor and of a sublingual angioma. After cardio-respiratory function evaluation, through a sternotomy, the patient underwent thymectomy and challenging resection of a hypervascularized mediastinal lesion adjacent to the right upper horn of the thymus, but apparently independent from it, and tenaciously adherent to the right innominate vein.

      4c3880bb027f159e801041b1021e88e8 Result

      Postoperative course was uneventful. Histopathology revealed a normal adipose thymic involution and a Masson's tumor or intravascular papillary endothelial hyperplasia with mediastinal localization. The patient underwent hemocoagulative and genetic tests, as Masson's tumor may be associated with thrombophilia and genetic syndromes.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Masson's tumor can clinically and radiologically mimic various benign and malignant mediastinal lesions, such as thymomas. The definitive diagnosis can be obtained only with the histological examination, demonstrating the presence of endothelial papillae, with a thin fibrous stroma, protruding into the vessel lumen. To the best of our knowledge, this is the first reported case of surgical treatment of a mediastinal Masson's tumor. However, surgical resection may be technically difficult due to the intrinsic hypervascularized nature of these pseudotumoral lesions.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.