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Primary Pulmonary Sarcoma

Primary Pulmonary Sarcoma. Wael Batobara. History. 78y Caucasian Male presented to ER 9 days SOBE , Dry Cough , Night Sweating X smoker >50 y ( 10 pack y ) Received 3 days Levofluxacin for ? CAP No Chest pain , Hemoptysis , Orthopnea or PND No Leg swelling No Change in Wt or appetite.

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Primary Pulmonary Sarcoma

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  1. Primary Pulmonary Sarcoma Wael Batobara

  2. History • 78y Caucasian Male presented to ER 9 days SOBE , Dry Cough , Night Sweating • X smoker >50 y ( 10 pack y ) • Received 3 days Levofluxacin for ? CAP • No Chest pain , Hemoptysis , Orthopnea or PND • No Leg swelling • No Change in Wt or appetite

  3. History • PMH : GERD , BPH & Knee OA • No contact with similar case • No recent travel • No pets or occupational exposure • NKA • Rx : PRN NSAID , H2 Blocker

  4. Examination • Afebrile BP 150/90 HR 100 regular • RR 20 Sat 93% on 5 liters O2 • No Pallor or Lymphadenopathy • Chest: Central Trachea Dull percussion Lt Lower 2/3 Post Absent breath sound Lt L 2/3 post • CVS ,Abd & LL NAD

  5. Investigation • CBC WBC & Plt  N HB 130 MCV N • PTT & INR  N • Lytes ,BUN & Creat  N • LFT , EKG & UA  N • ABG PH 7.38 PO2 75 3L O2 PCo2 35 HCO3 26 • CXR & Chest CT

  6. Investigation • Pleural Tapping  2.8 liters drained Serosanguinus exudate -ve cytology • CT Guided Bx  Spindle Cell Sarcoma • CT Head , Abd & Pelvis N

  7. Hospital Course • Seen By Thoracic Sx  Inoperable • Seen By Med.Onc.offered Chemo & XRT • Post tap CXR small effusion Not accessible By US • Improved SOB Sat 94% RA • Discharged Home • F/U Oncology clinic for XRT +/- Chemo

  8. Primary Lung Sarcoma • Incidence • Presenting Symptoms & Signs • Diagnosis • Treatment • Prognostic Factors

  9. Incidence • Sarcomas are rare malignant tumors arising from the mesenchymal tissues at all body sites and include a wide array of histopathologic types • 10,700 newly diagnosed sarcomas per year in the United States {0.80 percent of the 1,334,100 new malignant tumors } • 77 percent arise in soft tissue and the remainder in bone CA Cancer J Clin 2003 Jan-Feb

  10. Incidence • Primary Lung Sarcoma is Rare { 0.1-1% of all lung cancers} • From 1970 To 1999 In Hospital Louis Pardel 12 Cases Lung Cancer 38-2002 • From 1982 To1998 In Lille University Hospital  18 Cases Euro Jr Of Cardiothoracic Sx 18-2000

  11. Patients Characteristics • Male 7/12 Vs 7/18 • Female 5/12 Vs 11/18 • Mean age 50 Vs 53 • Smoking 7/12 Vs 8/18 • Asymptomatic 1/12 Vs 9/18 Lung Cancer 38-2002 Vs Euro Jr Of Cardiothoracic Sx 18-2000

  12. Symptoms & Signs • Chest pain ,SOB & Cough common • Fatigue , Wt loss less common • Supraclavicular LN & Pancoast Syn in 1 Pt • CXR & CT  Solitary masses Upper Lobe other features : cavitations ,effusions ,atelectasis ,chest wall & ribs involvements Lung Cancer 38-2002 & Euro Jr Of Cardiothoracic Sx 18-2000

  13. Bronchoscopy & Pathology • N 8/12 Vs 8/18 • Endobronchial lesion 1/12 Vs 7/18 • Extrinsic compression 3/12 Vs 3/18 • Most common type Leiomyosarcoma 7/12 then monophasic synovial sarcoma 2/12 • While in the other study Malignant Fibrous Histiocytoma 4/18 Undifferentiated Sarcoma 4/18 Lung Cancer 38-2002 & Euro Jr Of Cardiothoracic Sx 18-2000

  14. Diagnosis • PET Scan • 18 Patients with soft tissue sarcoma 4 Patients with benign soft tissue lesion • 100% sensitivity for sarcoma • Uptake correlate with tumor grade • Only one benign lesion showed uptake Journal of Nuclear Medicine Feb 1996

  15. Treatment & Prognosis • 9/12 Surgery 6 lobectomies & 3 pneumonectomies • 3/12 Inoperable : 1 Pancoast , 1 Age 1 locally advanced disease • 3/12 Chemotherapy Ifosamiade containing regimens IVA or IVAD CA Cancer J Clin 2003 Jan-Feb

  16. Treatment & Prognosis • 6/12 alive disease free • 6/12 died 4 from disease progression • 1,3,5 y Survival was 71,50,38 % • Relapse 5/12 4 intrathoracic Rx wit Chemo CA Cancer J Clin 2003 Jan-Feb

  17. Treatment & Prognosis • 15/18 Surgery • 3/18 pre op Chemo to shrink tumor size  successful in 2 patients 1 free resection margins 1 microscopic invasion Euro Jr Of Cardiothoracic Sx 18-2000

  18. Treatment & Prognosis • 9/18 died 5 from sarcoma • 9/18 alive till now 3 with recurrent disease which was resected in 2 • Significant correlation between stage & survival • 5 y survival 43% Euro Jr Of Cardiothoracic Sx 18-2000

  19. Thank You I hope It Was Not Boring

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