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Nirmal Kajal



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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: 2
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.CR-21 - Utility of Thoracoscopy in Diagnosis of Lung Tumour in Pleural Effusion (ID 12472)

      12:00 - 13:30  |  Author(s): Nirmal Kajal

      • Abstract
      • Slides

      Background

      Papillary adenocarcinoma of the lung is a rare malignancy accounts]ing for 7.4%–12% of the lung adenocarcinomas . A pleural metastasis is often accompanied by a malignant pleural effusion (MPE),can be one of the presentations of this disease. Differential diagnosis of exudative recurrent pleural effusion is often a lengthy process brimming with various snags. Contrary to thoracocentesis and closed pleural biopsy, thoracoscopy allows biopsy with direct visualization., Medical thoracoscopy increases the diagnostic yield in patients with pleural disease especially when thoracocentesis and closed pleural biopsy are non diagnostic

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We present case of 75 year old female housemaker with complaint of breathlessness and chest pain for the last 3 months. She was a never smoker and did not have any significant personal history. On physical examination and chest xray – a massive pleural effusion was seen on the left side. A chest tube was inserted. Because of unilateral haemorrhagic pleural fluid with an exudative pattern, medical thoracoscopy was performed . We observed a hepatized lung with severe pleural inflammation, medical thoracoscopy was done and biopsy was taken. Because of the family’s low economic status, we could not perform immunohistochemistry. Smear and culture of the pleural fluid were negative for tuberculosis. Cytology of the pleural fluid was positive for malignancy. On histopathology, Sections from the biopsy taken showed a malignant neoplasm with atypical cells arranged in a branching papillary pattern with fibrovascular cores .The papillae are lined by columnar cells with moderate amount of cytoplasm showing nuclear overlapping hyperchromasia and coarse chromatin. Few of the nuclei appear optically clear. Invasion into the deeper tissues is seen in the form of different sized angular and malignant glands surrounded by a dense desmoplastic stoma .Areas of necrosis, neutrophilic exudate and hemorrhage were also seen.

      4c3880bb027f159e801041b1021e88e8 Result

      Hence a diagnosis of stage IV papillary type of adenocarcinoma lung was made. And the patient was started on Chemotherapy but unfortunately she expired in the course of treatment.

      8eea62084ca7e541d918e823422bd82e Conclusion

      High index of suspicion should be kept for the possibility of malignancyin a massive pleural effusion especially when its being refilled – recurrently. Medical thoracoscopy is always helpful in diagnosis and management of these cases as seen in the present case report. In developing nations where interventional pulmonology is still not a routine procedure , by this case report we wish to highlight its importance.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P3.CR-22 - Pulmonary Tuberculosis – A Chameleon; Mimicking Lung Cancer on Imaging (ID 12292)

      12:00 - 13:30  |  Author(s): Nirmal Kajal

      • Abstract
      • Slides

      Background

      Tuberculosis (TB) often mimics other diseases including malignancy, and has been rightly called a benign imposter. Most common radiographic appearances seen in TB are cavitary, fibroproductive, exudative, acinary, micro and macronodular and miliary types.The typical presentation of pulmonary tuberculosis is easily recognisable but the disease, a well-known masquerader, can be a source of diagnostic confusion radiologically when the presentation is atypical., especially in the regions in which the tuberculosis is endemic. Tuberculosis may be radiographically revealed as mass formation in the cases clinically and radiographically examined, difficulties may be encountered in the differential diagnosis due to the similar constitutional symptoms such as fatigue, breathlessness , and anorexia both in tuberculosis and carcinoma, and the radiologic appearance is also confusing.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A 65 year old female patient was referred to our department with a 3 months history of breathlessness, chest tightness, intermittent non-productive cough and unintended weight loss of 5 kg in the past 2 months. She had no reported fever or any prior medical history. A presumptive diagnosis of lung cancer was made from elsewhere based on her radiological appearance on computed tomography (CT) scan of chest which showed a large peripherally located enhancing solid mass lesion in the posterobasal segment of right lower lobe and another solid necrotic lesion in right middle lobe abutting the pericardium along with multiple nodular opacities. CT guided fine needle aspiration cytology was done from the lesion and it showed acute on chronic inflammation. The next diagnostic step was bronchoscopy with negative results regarding malignancy. The bronchial wash samples were also sent to microbiology with negative results for bacteria, fungi, even negative on direct microscopy but Cartridge based nucleic acid amplification test (CBNAAT) (Polymerase Chain Reaction based) for Mycobacterium tuberculosis provided the diagnosis by showing growth of the Mycobacterium tuberculosis.

      4c3880bb027f159e801041b1021e88e8 Result

      The patient was diagnosed as pulmonary tuberculosis and started on standard anti-TB-therapy and she responded symptomatically as well as with clearing of the lesion, radiologically.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In conclusion, tuberculosis emerging as a large nodular or mass-like radiographic appearance is uncommon and this can be easily confused with the tumoral formations. Differentiation from lung cancer based on imaging findings alone may be challenging and often ambiguous, thereby highlighting the importance of use of interventions like bronchoscopy in suspecting cases.

      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.