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Cesare Braggio
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EP1.09 - Pathology (ID 199)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.09-11 - Lipoid Pneumonia Resembling Bilateral Lung Cancer: Be Aware of Nasal Decongestants! (Now Available) (ID 2378)
08:00 - 18:00 | Presenting Author(s): Cesare Braggio
- Abstract
Background
To describe a case of bilateral exogenous lipoid pneumonia mimicking lung cancer in a patient affected by obstructive sleep apnea syndrome treated with decongestants mineral oils.
Method
A 57 year-old male patient was referred to our surgical department for an incidental finding of a bilateral pulmonary mass during a chest X-ray made for chronic coughing. His past medical history was unremarkable; he was an everyday smoker with a 80pack/years and he was affected by obstructive sleep apnea syndrome. A chest CT and CT/PET scans was subsequently done and revealed the presence of a both pulmonary consolidations of the lower lobes bilaterally with increase in uptake of FDG (Fig. 1A-B): mediastinal lymph node was normal, no other lesions was found. Morphology of the lesions was strongly suspect for non small cells lung cancer, so the patient underwent a CT-guided lung biopsy.
Result
A percutaneous CT-guided lung biopsy was done in the right lower lobe. The histological examination was consistent with pulmonary adenocarcinoma with signet-ring cell features (Fig.1C): therefore, the patient was addressed to conventional chemotherapy. At that point, a multidisciplinary discussion was done: a careful revision of the chest CT-scan was carried out and focal areas of fat attenuation within the lung consolidations were observed. According to that finding, a diagnosis of lipoid pneumonia was hypothesized. A more careful questioning about patient’s medical history revealed the use of daily nasal decongestants during the last 4 years due to chronic rhinitis secondary to OSAS: the drug was composed of mineral oils. A further blind revision of the histological tissue samples was requested and confirmed the diagnosis of exogenous lipoid pneumonia. The patient was invited to discontinue the nasal oil decongestant. No other pharmacological treatment was started. Six months later, a chest CT-scan was performed but no significant changing of the pulmonary consolidations were observed (Fig. 1D). Currently, the patient is well and a reduction of chronic coughing was reported.
Conclusion
Exogenous lipoid pneumonia is a rare condition that might be misdiagnosed with lung cancer; for this reason it should be considered in the differential diagnosis of pulmonary consolidations, especially when occurring bilaterally. A precise medical history could be resolutive.
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EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.15-01 - Spontaneous Mediastinal Hematoma Resembling Mediastinal Tumor in a Haemophiliac Patient (Now Available) (ID 2415)
08:00 - 18:00 | Presenting Author(s): Cesare Braggio
- Abstract
Background
To describe an extremely rare case of spontaneous mediastinal hematoma secondary to a thymic cyst bleeding and its surgical treatment in a patient with haemophilia A.
Method
A 22-year-old male was admitted to the Emergency Department for chest pain, fever and haematuria arisen four days before. He was a heavy smoker with a previous diagnosis of haemophilia A (factor VIII deficiency). Vital signs showed tachycardia (110 beats per minute) and fever (37.5°C); physical examination showed a superior vena cava syndrome with oedema of the neck and the left harm. Hematological examination revealed only a prolonged clotting time compatible with his hemophilic disorder. A chest X-ray was performed and a mediastinal widening was revealed. A subsequent chest CT-scan showed a mediastinal mass of 77x35x85mm with compression of the left subclavian vein and superior vena cava (Fig. 1A). A suspect of lymphoma was posed and a surgical biopsy was planned.
Result
Through a right uniportal VATS, the anterior mediastinal pleura was incised to reach the mass, and suddenly 400ml of hematinic liquid leaked out and multiple biopsies of the remnant mediastinal tissue were performed. A mediastinal hematoma was then suspected. Post-operative chest X-ray showed a reduction of the mediastinal widening. A chest CT scan performed a few days later revealed an impressive reduction of the mass (Fig. 1B). Histological examination was consistent with a thymic cyst surrounded by a large amount of haemorrhagic and inflammatory tissue. A chest MRI at 3 and 6 month after surgery demonstrated a gradual and complete reduction of the mediastinal mass (Fig. 1C).
Conclusion
Spontaneous mediastinal hematoma is a very rare condition that could radiologically be misdiagnosed with a mediastinal tumour. A suspect must be posed in patients with bleeding disorders presenting with a mediastinal widening.
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EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.17-14 - Less Is More: An Unusual Case of Benign Emptying of the Post - Pneumonectomy Space (Now Available) (ID 2362)
08:00 - 18:00 | Author(s): Cesare Braggio
- Abstract
Background
To describe an unusual case of benign emptying of the post-pneumonectomy space.
Method
A 68-years-old man presented to our clinic with a large swelling located on the previous thoracotomy increasing at Valsalva maneuvers. One month before he underwent right pneumonectomy for lung adenocarcinoma. He was discharged on the seventh post-operative day uneventfully. Patient denied any history of chest trauma, fever, neither productive cough nor vomica. Chest X-Ray showed a drop of the air-fluid level within the post-pneumonectomy space. Suspecting of a broncho-pleural fistula (BPF), patient underwent a flexible fiberoptic bronchoscopy which showed a regular bronchial stump. A chest CT-scan revealed an empty right hemithorax associated with an air collection in the subcutaneous tissues. No pleural puncture was performed, in order to avoid any contaminations of the pleural cavity. A BPF was ruled out; a watchful waiting approach without surgical intervention or antimicrobial therapy was decided. A roentgenogram 10 weeks later showed the almost refill of the pleural cavity and at physical examination the swelling was dramatically decreased. At chest CT-scan 3 months later the post-pneumonectomy space was completely filled by fluid associated with an overexpansion of the residual lung. After one year the patient is healthy and disease-free.
Result
Patient’s presentation meets the clinical and laboratory criteria of Benign Emptying of the Postpneumonectomy Space (BEPS) (afebrile, normal WBC, no fluid expectoration, negative bronchoscopy, negative pleural culture if performed). Among the hypotheses about the pathogenesis of BEPS we advocated the valve-like mechanisms of “occult bronchopleural fistula”, which was large enough to let enter only air into the postpneumonectomy space although arresting the passage of pleural effusion to the airways. A spontaneous healing of the micro-fistula was maybe the underlying mechanisms of the refilling of the thoracic cavity. BEPS seldom occurred after pneumonectomy although it should be considered during differential diagnosis of a sudden drop of the pleural fluid especially in asymptomatic patients, in order to avoid unnecessary invasive procedures.
Conclusion
Benign emptying of the postpneumonectomy space should be considered when facing with a sudden drop of the pleural fluid in asymptomatic patients in order to avoid unnecessary invasive procedures.
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P2.09 - Pathology (ID 174)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.09-02 - Exploring the Features of the Short and Long-Term Survivors for Lung Adenocarcinoma: A Single Center Experience (Now Available) (ID 2808)
10:15 - 18:15 | Author(s): Cesare Braggio
- Abstract
Background
The aim of this study was to identify an objective way to define a long-term survivors(LTS) and short-term survivors(STS) in patients with surgically resected lung adenocarcinoma (ADK), and secondly to find peculiar clinicopathological features in these two groups of patients.
Method
all patients who underwent major lung resection for lung ADK from 2000 to 2015 were studied.LTS and STS were extrapolated considering the overall survival(OS) and pathological tumour stage:the first and the fourth quartile of those patients with cancer-related death were considered for statistical analysis.
Result
from 600 ADK patients we found 79 STS and 77 LTS;clinico-pathologic baseline characteristics are presented in Table 1.Considering STS patients, smoking habit, histotype, tumour necrosis, pleural invasion and pathological stage were significantly associated with OS at univariate analysis (Fig.1). In LTS patients, smoking habit, neoadjuvant chemotherapy, tumour-infiltrated lymphocytes and pathological stage were significantly associated with OS (Fig.2).On multivariate analysis, smoking status, lymphoid infiltrate, pleural invasion and stage remained significantly associated with OS (Table 2).
Table 1
Variable
Full samplea
STS (N=79)a
LTS (N=77)a
p-value
Age at diagnosis (median)
68 (62-74)
68 (61-74)
69 (64-75)
0.301
Gender (M:F)
110:46 (70.5%:29.5%)
60:19 (24,1%:75,9%)
27:50 (35,1%:64,9%)
0.131
Smoking status
<0.001
Never smoker
23 (19,6%)
5 (6,8%)
18 (27,3%)
Smoker + Former smoker
117 (81,4%)
69 (93,2%)
48 (72,7%)
Other previous primary tumor
0.936
Yes
43 (27,6%)
22 (27,8%)
21 (27,3%)
No
113 (72,4%)
57 (72,2%)
56 (72,7%)
Side
0.079
Right
70 (44,9%)
30 (38,0%)
40 (51,9%)
Left
86 (55,1%)
49 (62,0%)
37 (48,1%)
Histotype
0.085
Lepidic
5 (3,2%)
0 (0,0%)
5 (6,5%)
Papillary
21 (13,5%)
11 (13,9%)
10 (13,0%)
Acinar
37 (23,7%)
16 (20,3%)
21 (27,3%)
Micropapillary
18 (11,5%)
8 (10,1%)
10 (13,0%)
Solid
75 (48,1%)
44 (55,7%)
31 (40,3%)
Grade
0.034
G1
2 (1,3%)
0 (0,0%)
2 (2,6%)
G2
23 (14,7%)
7 (8,9%)
16 (20,8%)
G3
131 (84,0%)
72 (91,1%)
59 (76,6%)
Lymphatic invasion
0.864
Yes
101 (64,7%)
51 (67,1%)
50 (65,8%)
No
51 (32,7%)
25 (32,9%)
26 (34,2%)
Blood invasion
0.128
Yes
47 (30,1%)
28 (36,4%)
19 (25,0%)
No
106 (67,9%)
49 (63,6%)
57 (75,0%)
Pleural invasion
0.439
PL0
78 (50,0%)
37 (46,8%)
41 (53,2%)
PL1
41 (26,3%)
24 (30,4%)
17 (22,1%)
PL2
20 (12,8%)
8 (10,1%)
12 (15,6%)
PL3
17 (10,9%)
10 (12,7%)
7 (9,1%)
Necrosis
0.419
Yes
70 (46,7%)
37 (50,0%)
33 (43,4%)
No
80 (53,3%)
37 (50,0%)
43 (56,6%)
Lymphoid infiltrate
0.787
Absent
57 (37,0%)
27 (35,1%)
30 (39,0%)
Mild
63 (40,9%)
34 (44,2%)
29 (37,7%)
Moderate
21 (13,6%)
9 (11,7%)
12 (15,6%)
Marked
13 (8,4%)
7 (9,1%)
6 (7,8%)
Neoadjuvant chemotherapy
0.371
Yes
11 (7,1%)
7 (8,9%)
4 (5,2%)
No
145 (92,9%)
72 (91,1%)
73 (94,8%)
Table 2
Variables
p-value.
HR
95% CI
Smoking Habit
0,003
2,317
1,325
4,052
Histotype
0,817
,951
,620
1,459
Tumor Necrosis
0,065
,667
,434
1,025
Limphoyd Infiltrate
0,024
1,598
1,063
2,402
Neoadjuvant CHT
0,160
,502
,192
1,313
Pleural Invasion
0,021
,421
,201
,879
Stage
0,002
,480
,305
,755
Conclusion
Our findings suggest that the unexpected survival of STS and LTS ADK-patients is determined by a concert of clinical and pathological features. Biological characterizazion of these kind of patients will likely improve the understanding of their unusual course.
