1 / 19

Case Study: Primary Pulmonary Sarcoma in a 78-Year-Old Male with SOB and Dry Cough

A 78-year-old male patient presented with shortness of breath, dry cough, and night sweats. A smoking history of over 50 years and a recent course of antibiotics for suspected community-acquired pneumonia were noted. Chest imaging revealed a pleural effusion, leading to a CT-guided biopsy that diagnosed spindle cell sarcoma. Despite thoracic surgery's assessment of inoperability, the patient was offered chemotherapy and radiation therapy. This case illustrates the rarity of primary lung sarcoma and underscores the importance of prompt diagnosis and multi-disciplinary treatment approaches.

jewel
Télécharger la présentation

Case Study: Primary Pulmonary Sarcoma in a 78-Year-Old Male with SOB and Dry Cough

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related