Primary pulmonary meningioma presenting as lung metastasis

A benign primary pulmonary meningioma, an extremely rare tumour, was incidentally detected in a 57-year-old woman in association with a contralateral pulmonary adenocarcinoma. The meningioma was initially suspected to be a metastasis. Both tumours were excised, with excellent outcome. Anatomic features of primary pulmonary meningioma and differential diagnosis are discussed.     

Primary pulmonary meningioma

Primary pulmonary meningiomas are extremely rare. In this article we report one case with benign primary pulmonary meningioma. The literature is reviewed and the clinical manifestations, radiographic findings, and pathologic features are presented.     

Primary pulmonary malignant meningioma

Primary pulmonary meningiomas are relatively rare and mostly benign. To exclude pulmonary metastasis of an intracranial meningioma, imaging studies of the brain should be performed. We believe that only one primary pulmonary malignant meningioma in which a metastasis from the brain was excluded has been reported. In this report we describe a second case with malignant features.     

Primary pulmonary meningioma; report of a case

Primary pulmonary meningiomas are quite rare, and their occurrence has been reported only sporadically. A 49-year-old, asymptomatic female was hospitalized for the evaluation of a coin lesion in the left lung radiography. She has no history of previous neoplasm or symptom referable to the central nervous system. Chest computed tomography (CT) demonstrated a 9 x 14 mm, round, noncalcified, well-demarcated lesion in the left upper lobe of the lung (S(1+2)). For diagnostic purposes, enucleation of the tumor was performed. The resected specimen revealed histologically classical typical meningioma. Because postoperative magnetic resonance imaging (MRI) of the brain did not show any intracranial mass, this case was and diagnosed as a primary pulmonary meningioma. The patient was discharged with no complication, and alive without recurrence of disease 14 months after surgery.     

Primary pulmonary myxoma

We report a case of a primary pulmonary myxoma. The patient was a 69-year-old previously healthy human. Computed tomographic scan demonstrated a well-circumscribed tumor with a diameter of approximately 13 mm in the right upper lobe. We performed a right upper lobectomy under video-assisted thoracoscopy. Microscopic examination of the tumor disclosed elongated and stellate cells in a myxoid stroma, typical of myxoma.     

Primary pulmonary malignant meningioma.

Fewer than 20 cases of primary pulmonary meningioma have been reported. Most of these cases have been histologically and clinically benign. We report an unusual case of primary pulmonary malignant meningioma with atypical histologic features and malignant behavior. A computed tomography scan of the head did not show evidence of tumor. The right upper lobe mass was resected and showed features of an atypical meningioma with loss of architectural pattern, mild nuclear pleomorphism, increased mitotic counts (up to 15 mitotic figures per 10 high power fields), and focally prominent nucleoli. Focally, cells with rhabdoid features were identified. The tumor's immunohistochemical and ultrastructural profiles were consistent with a meningioma. The tumor stained negative for estrogen and focally positive for progesterone receptors and had a MIB-1 labeling index (marker of cell proliferation) of 9.2%. Approximately 5 months after the initial resection, the patient experienced a tumor recurrence with multiple lymph node metastases, spread to the middle and lower lobes of the right lung, and metastasis to the diaphragm. Rarely, primary pulmonary meningiomas may present as high-grade malignant lesions.     

Successful resection of giant solitary pulmonary metastasis from a phyllodes tumor

Phyllodes tumors are rare fibroepithelial tumors that make up less than 1% of all breast tumors. Malignant phyllodes tumors are associated with a 25% incidence of distant metastasis, which is invariably fatal within 24 months. We report successful resection of a solitary pulmonary metastasis in the left chest in a 50-year-old woman 7 years after a right-sided mastectomy for malignant phyllodes tumor.     

Papillary meningioma with pulmonary metastasis. Case report

Successful surgical treatment by extirpation of remote metastases is extremely rare. A patient was admitted in whom multiple metastases to the lung occurred 8 years after extirpation of a papillary meningioma of the posterior fossa. The meningioma did not recur at the original site. The pulmonary metastases were surgically removed. The histological and electron microscopic findings of this case are presented.     

Primary lung cancer with pulmonary hypertrophic osteoarthropathy mimicking bone metastasis; report of a case

A 64-year-old man visited our hospital, due to right shoulder pain and fever. Chest X-ray revealed a well-defined tumor in the upper field of the left lung, and the histological diagnosis was adenocarcinoma. Bone scintigraphy demonstrated abnormal accumulation localized in the right shoulder joints. Although bone metastasis was highly suspected, pulmonary resection was performed to remove infected pulmonary tumor. A week after pulmonary resection, his shoulder pain dramatically improved, and abnormal accumulation in bone scan decreased definitely 1 month later. In conclusions, this is an atypical case of hypertrophic osteoarthropathy accompanying lung cancer.     

True pulmonary carcinosarcoma suspected as a metastatic lung tumor

This patient, a 53-year-old man, has underwent operation on the diagnosis of esophageal cancer 2 years ago. An abnormal shadow was detected in the left lung field and he was admitted to our hospital for further examination. On the suspicion of metastatic lung tumor by transbronchial brushing cytology, partial resection of the left lower lobe was performed. Histologically the tumor was of carcinomatous (squamous cell carcinoma and adenocarcinoma) and sarcomatous (fibrosarcoma and chondrosarcoma) elements, so the patient was diagnosed as "true" pulmonary carcinosarcoma. True pulmonary carcinosarcoma is one of the very rarest neoplasms of the lung.     

Horseshoe lung with left lung hypoplasia and critical pulmonary venous stenosis

Horseshoe lung is a rare congenital anomaly characterized by an isthmus of the pulmonary parenchyma that extends posterior to the pericardial reflection at the cardiac apex and across the midline. There is unilateral, usually right-lung hypoplasia and most cases are associated with the scimitar syndrome. We present the case of an infant with horseshoe lung but with hypoplasia of the left lung and levocardia that was not associated with the scimitar syndrome.     

Donor transfer of pulmonary coccidioidomycosis in lung transplantation

Transplant recipients living in endemic areas are at high risk of aerosol-transmitted fungal infections because of environmental exposure while on immunosuppressive drugs, as well as reactivation of latent infection from either the patient's or the donor's organs. The latter may account for early development of coccidioidomycosis after transplantation. We describe a case of pulmonary coccidioidomycosis in a lung transplant recipient who acquired the infection from the donor lung and presented with fulminant pneumonia in the immediate postoperative period.     

Fluorodeoxyglucose positron emission tomography improves preoperative staging of resectable lung metastasis

OBJECTIVE: F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is now a procedure of proven clinical value in the staging of primary lung cancer. This study evaluated the role of PET in the preoperative assessment of resectable lung metastases. METHODS: Eighty-six patients with previously treated malignancy and proven or suspected lung metastases, deemed resectable at computed tomography scan, were investigated with 89 preoperative PET procedures. Primary tumor sites were: gastrointestinal in 32 cases, sarcoma in 13, urologic in 14, breast in 8, head and neck in 7, gynecologic in 5, thymus in 5, other in 5. Seventy lung resections were performed in 68 patients of whom only 54 proved to be lung metastasis, 7 were primary lung tumors, and 9 were benign lesions. RESULTS: In 19 cases (21%) lung surgery was excluded on the basis of PET scan results due to extrapulmonary metastases (11 cases), primary site recurrence (2), mediastinal adenopathy (2), or benign disease (4). All mediastinal node metastases (7 cases) were detected by PET with a sensitivity, accuracy, and negative predictive value for mediastinal staging of 100%, 96%, and 100%, respectively, versus 71%, 92%, and 95% of the computed tomography scan. In the group of patients who underwent lung resection, PET sensitivity for detection of lung metastasis was 87%. CONCLUSIONS: PET scan proved to be a valuable staging procedure in patients with clinically resectable lung metastasis and changed the therapeutic management in a high proportion of cases.     

Use of quantitative lung scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing lobectomy

Background

In patients with non-small cell lung cancer, the only realistic chance of cure is surgical resection. However, in some of these patients there is such poor respiratory reserve that surgery can result in an unacceptable quality of life. In order to identify these patients, various pulmonary function tests and scintigraphic techniques have been used. The current American College of Physicians and British Thoracic Society guidelines do not recommend the use of quantitative ventilation-perfusion scintigraphy to predict postoperative function in lung cancer patients undergoing lobectomy. These guidelines may have been influenced by previous scintigraphic studies performed over a decade ago. Since then there have been advances in both surgical techniques and scintigraphic techniques, and the surgical population has become older and more female represented.

Methods

We prospectively performed spirometry and quantitative ventilation-perfusion scintigraphy on 61 consecutive patients undergoing lobectomy for lung cancer. Spirometry was repeated one-month postsurgery. Both a simple segment counting technique alone and scintigraphy were used to predict the postoperative lung function.

Results

There was statistically significant correlation (p < 0.01) between the predicted postoperative lung function using both the simple segment counting technique and the scintigraphic techniques. However, the correlation using simple segment counting was of negligible difference compared to scintigraphy.

Conclusions

In keeping with current American Chest Physician and British Thoracic Society guidelines, our results suggest that quantitative ventilation-perfusion scintigraphy is not necessary in the preoperative assessment of lung cancer patients undergoing lobectomy. The simple segmenting technique can be used to predict postoperative lung function in lobectomy patients.     

A new thoracoscopic lung biopsy clamp simplifies excision of pulmonary nodules

Excision of a pulmonary nodule by video-assisted thoracoscopic surgery can be difficult when the lesion is deep to the pleural surface. As lung staples are applied, the lung lesion may retract centrally, making continued localization by palpation impossible. We describe a thoracoscopic lung clamp with a novel open end allowing gentle retraction and continuous localization of the nodule during a video-assisted thoracoscopic surgery biopsy.     

Use of three-dimensional computed tomographic angiography of pulmonary vessels for lung resections

BACKGROUND: Identification and appropriate treatment of the pulmonary artery (PA) is a key to successful anatomic resection of the lung. Preoperative identification of branching pattern of the PA seems to make pulmonary resection easier and safer especially when there is severe adhesion or incomplete fissure between the lobes. With the development of the multidetector row spiral computed tomography (MDCT), three-dimensional (3D) CT angiography can be obtained easily and can provide very useful information about various organs. We studied the usefulness of 3D-CT pulmonary angiography (3D-CTPA) in evaluating the PA branching pattern before anatomic pulmonary resection. METHODS: Fourteen patients with primary lung cancer undergoing anatomic pulmonary resections were the subjects of this study. The 3D-CTPA images were obtained using MDCT. The obtained images of the PA branching pattern were compared with intraoperative findings in each case at the time of thoracotomy. RESULTS: MDCT scanning required approximately 15 seconds per patient during a single respiratory pause and the 3D images were processed within 10 minutes after scannning. According to intraoperative findings, 98% (84 of 86) of PA branches were revealed to be successfully identified on preoperative 3D-CTPA. Two missed branches on 3D-CTPA were small vessels, which were less than 1.5 mm in actual diameter. Pulmonary vessels were clearly identified even when contrast medium was not administered intravenously. CONCLUSIONS: Obtaining 3D-CTPA using MDCT is noninvasive yet it provides precise preoperative information regarding pulmonary vessels. This technique is a far less invasive and an easier investigation than conventional pulmonary angiography. The 3D-CTPA navigation may have the potential to increase the safety of surgical procedure and to reduce surgical morbidity in anatomic lung resection.     

New treatment method for reexpansion pulmonary edema: differential lung ventilation

Reexpansion pulmonary edema (REPE) is an iatrogenic complication that develops in a lung rapidly reinflated after varied periods of collapse. Though infrequent, it is often lethal. Measures to prevent REPE are well known and mild cases may be reversed with conventional ventilator therapy and medication; however, there is no definitive treatment for this condition in its severest forms. Asynchronous differential lung ventilation is a relatively new therapeutic modality for preoperative, intraoperative, or postoperative treatment of respiratory failure secondary to ventilation-perfusion mismatch. Successful treatment of severe REPE in a 29-year-old male patient is described, using asynchronous differential lung ventilation.