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Agnese Nesti



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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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      EP1.15-22 - Primary Epithelial - Myoepithelial Carcinoma of the Lung with Unexpected Aggressive Onset (Now Available) (ID 1110)

      08:00 - 18:00  |  Author(s): Agnese Nesti

      • Abstract
      • Slides

      Background

      Epithelial-myoepithelial carcinoma (EMC) is the rarest sub-type of primary salivary gland type neoplasms of the lung. It usually arises from the salivary glands in the trachea or main bronchi and it is generally classified as a low-grade tumour, but because of its rarity and the unknown malignant potential, the treatment of choice has not been established.

      Method

      A 50-year old Hispanic woman, with no history of previous malignancies or comorbidities, arrived at our institution with cough and dyspnoea. A chest CT showed a lesion of left upper lobe (LUL) bronchus, associated to complete atelectasis of left lung, pleural effusion and two inhomogeneous pleural masses just over the diaphragm. PET/CT revealed increased FDG uptake in LUL and in pleural lesions. Fiberbronchoscopy showed a mass originating from left upper bronchus that occluded left main bronchus. The biopsy of the neoplasm revealed pulmonary EMC. The cytological examination of pleural effusion was negative for neoplastic cells. After cardio-respiratory complete assessment and tumour board evaluation, the patient underwent left pneumonectomy, systematic lymphadenectomy and removal of two solitary lesions respectively located on parietal pleural and on diaphragm en-block with portion of muscle (repaired with non-absorbable running suture) by thoracotomy

      preoperative computed tomography images.jpg

      Result

      The postoperative course was uneventful (hospitalization: 10 days), however two weeks after discharge the patients was readmitted with pleural effusion and fever. The patient underwent a left thoracentesis (amicrobic, no malignant cells) and a fiberbronchoscopy (regular bronchial suture). After 7 days the patient was discharged. Histopathology confirmed R0 resection of EMC (7x5.5x4 cm), and two solitary metastases on parietal pleura and diaphragm. Ki 67 was <30%. Patient underwent adjuvant chemotherapy, was alive and free of disease 32 months after surgery.

      Conclusion

      Primary EMC of the lung is an extremely rare neoplasm with an unpredictable biological behaviour. The surgical resection represents the gold standard if a complete resection can be reached

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