Liposarcoma of the pleural cavity

We report a case of pleural liposarcoma in a 58-year-old male patient with a twenty-year history of smoking, who was admitted for chest pain and chronic cough. Pleural liposarcoma is a rare, highly malignant intrathoracic tumor arising from the soft tissue of the pleural cavity. Chest radiograph and CT scan revealed a homogeneous mass with subtotal opacification of the left hemithorax. Tumor diagnosis was based on histopathological examination of a transparietal biopsy and revealed a mixed type liposarcoma. Surgical resection was performed followed by adjuvant irradiation. No recurrence was diagnosed during the follow-up period of ten months and the patient continues to do well at the time of writing this paper.     

青年恶性胸膜间皮瘤1例临床分析

目的探讨恶性胸膜间皮瘤（MPM）的临床特点、诊断及治疗。方法报告2013年2月甘肃省人民医院呼吸科收治的1例青年MPM病例及相关内容综述。结果患者,男,20岁,否认石棉接触史,咳嗽、气短2周,胸片提示左侧大量胸腔积液。引流胸水10000ml后复查胸部CT示左侧胸腔内低密度肿块影,行胸膜穿刺活检,病理结果为：MPM（腺管乳头状型）。结合此例患者特点和文献复习,青年MPM患者少见,可仅表现为胸腔积液,亦可无任何临床表现。结论MPM属高度侵袭性肿瘤,临床表现缺乏特异性,可发生于任何年龄,亦可无石棉接触史,需提高对该疾病的认识及诊断水平,以便早期诊断、早期治疗,提高患者生存质量及生存期。     

Potentially disseminated solitary fibrous tumor of the pleura: a case report

We report a case involving a female patient with frequent relapse, pleural dissemination, and port site recurrence (PSR) of a pleural solitary fibrous tumor (SFT). At the age of 55 years, she underwent tumor resection via video-assisted thoracoscopic surgery (VATS). The tumor arose from the mediastinal pleura; it was 7 cm in diameter and well demarcated. Histological examination showed neither hemorrhage nor necrosis, but moderate cellularity was present, and the Ki-67 labeling index was 15%. Despite complete resection, the tumor relapsed in the ipsilateral thoracic cavity 3 years postoperatively, and thoracoscopic complete tumor resection was performed; however, pleural lavage cytology (PLC) showed the presence of tumor cells. Multiple pleural dissemination and PSR developed 7 years after the initial surgery. The port site recurrent tumor was resected with the intercostal muscle via VATS. This case illustrates that a SFT may disseminate despite the fact that histological examination shows no evidence of malignancy.     

可弯曲式内科胸腔镜在恶性胸膜间皮瘤中的诊断价值

目的探讨可弯曲式胸腔镜对恶性胸膜间皮瘤的诊断价值。方法对30例不明原因胸腔积液患者进行胸腔镜检查。全麻下于腋部胸壁第6～7肋间置入胸腔镜套管,吸去大部分胸腔积液后按照内、前、上、后、侧、下的顺序观察胸膜腔并进行胸膜活检。结果 30例患者中有6例经直视下取活检病理证实为恶性胸膜间皮瘤。结论胸膜间皮瘤,单纯依靠影像学诊断较为困难,通过内科胸腔镜可在直视下取到理想的胸膜组织,提高了诊断阳性率。     

Malignant glomus tumor in pleural cavity

Glomus tumors, an uncommon hypervascular tumor, arise from modified smooth muscle cells of the glomus body that plays a significant role in the regulation of skin circulation. The tumors are usually located in the extremities, typically in the subungual region of the fingers. Primary glomus tumors of the chest are extremely rare, and to our knowledge, there are no cases have been described in thoracic cavity to date. We here report a case of intrathoracic glomus tumor in a 31-year-old man who presented with a persistent chest pain. Chest computed tomography scans demonstrated an irregularly shaped mass in the left thorax. Left thoracotomy was performed under the suspicious diagnosis of unexplained thorax tumor, and a tumor located in the left upper portion of thorax was founded. Complete resection of tumor along with the partial structure of chest wall was performed. Postoperative diagnosis was malignant glomus tumor.     

Persistent symptomatic pleural effusion following coronary bypass surgery: clinical and histologic features,and treatment

Pleural effusions following coronary artery bypass grafting (CABG) have been reported in 65%–89% of the cases. The majority of pleural effusions are left-sided, of little significance, and resolve spontaneously. However, a few pleural effusions require specific therapeutics. We report clinical and pleural histologic features of three patients who had persistent post-CABG pleural effusions and underwent video-assisted thoracic surgery (VATS). These patients were studied because they had a persistent pleural effusion within the first 2 months after CABG without other identifiable causes. All patients underwent VATS for investigation and management of persistent pleural effusions. Three patients with a mean age of 63.6 ± 8.5 years were studied. The pleural effusion developed 38 ± 11.3 days after CABG (range: 22–46). The median period from CABG to VATS was 80 ± 21.6 days (range: 50–100). In all cases, the pleural effusion was large, and predominated on the left side. Pleural effusions were characterized by an exudative (n = 2) or transudative (n = 1) fluid with lymphocytosis. Histologic examination of pleural biopsies showed a follicular lymphoid hyperplasia involving the pleural serosa and a non-necrotizing granulomatous reaction with a mild inflammatory infiltrate. All patients underwent VATS with intrapleural injection of sclerosing agents. Video-assisted thoracic surgery talc pleurodesis led to symptomatic and radiologic improvement in all patients with a mean follow-up of 16.7 ± 4.5 months. No recurrence of pleural effusion has been observed in any patient. Large pleural effusions can develop in a small proportion of patients after CABG. The mechanism of pleural effusion remains unclear. Video-assisted thoracic surgery could play a significant role in the management of pleural effusion developing after CABG.     

Trans-aortic excision of intraventricular lipoma with the assistance of arthroscopic camera

Cardiac lipomas are extremely rare benign neoplasms of the heart. We report the case of a 64-year-old female complaining of rapidly worsening dyspnea and lower limb edema. Echocardiograms showed a large hyperechoic mass which occupied the left ventricle. The cardiac nuclear magnetic resonance allowed the diagnosis of the left ventricular tumor of lipoma or liposarcoma. The tumor was resected through the ascending aorta, without injuring neither the aortic valve nor the left ventricle. Histological diagnosis showed that the tumor was a lipoma. The patient had an uneventful recovery, with no recurrence two years later.KEY WORDS : Lipoma, cardiac neoplasms, trans-aortic excision, interventricular septum     

Giant thymolipoma

Thymolipoma is an uncommon benign tumor (accounting for 2% to 9% of thymus tumors). We present the case of a 26-year-old man who sought medical attention for left-sided pleural pain of 3 months duration. Computed tomography showed a mass in the left side of the chest occupying both the anterior mediastinum and the left pleural cavity. This mass caused lung collapse and mediastinal shift. Magnetic resonance imaging revealed a large fatty tumor and transthoracic biopsy with radiological guidance confirmed the diagnosis. The tumor was resected through a left thoracotomy. No postsurgical complications occurred and the histopathological diagnosis was thymolipoma.     

Pleural involvement in lung cancer

The pleural space, a sterile secluded environment in the thoracic cavity, represents an attractive metastatic site for various cancers of lung, breast and gastrointestinal origins. Whereas lung and breast adenocarcinomas could invade the pleural space because of their anatomic proximity, “distant” cancers like ovarian or gastrointestinal tract adenocarcinomas may employ more active mechanisms to the same end. A pleural metastasis is often accompanied by a malignant pleural effusion (MPE), an unfavorable complication that severely restricts the quality of life and expectancy of the cancer patient. MPE is the net “product” of three different processes, namely inflammation, enhanced angiogenesis and vascular leakage. Current efforts are focusing on the identification of cancer cell autocrine (specific mutation spectra and biochemical pathways) and paracrine (cytokine and chemokine signals) characteristics as well as host features (immunological or other) that underlie the MPE phenotype. Herein we examine the pleural histology, cytology and molecular characteristics that make the pleural cavity an attractive metastasis destination for lung adenocarcinoma. Mesothelial and tumor features that may account for the tumor’s ability to invade the pleural space are highlighted. Finally, possible therapeutic interventions specifically targeting MPE are discussed.     

经内科胸腔镜冷冻胸膜活检对不明原因胸腔积液诊断的有效性及安全性研究

目的探讨经内科胸腔镜冷冻胸膜活检对不明原因胸腔积液诊断的有效性及安全性。方法采用前瞻性自身对照研究方法,对2017年9月-2018年9月中国科学院大学深圳医院收治的102例渗出性胸腔积液住院患者,在内科胸腔镜下分别进行常规胸膜活检和冷冻胸膜活检。比较两种活检方法获取的标本大小、病理阳性率、并发症的差异。结果冷冻胸膜活检获取的标本直径明显大于常规活检方法(6.5±1.2)mm vs(2.3±0.3)mm,差异有显著统计学意义(t=81.671,P<0.01)。冷冻胸膜活检组病理阳性率明显高于常规活检组(97.1%vs 90.2%),差异有统计学意义(P<0.05)。两组间出血方面无统计学差异(P>0.05)。结论经内科胸腔镜冷冻胸膜活检对不明原因胸腔积液诊断阳性率高,安全性好,值得重视和推广。     

胸膜腔内骨外骨肉瘤一例并文献复习

目的 报道1例胸膜腔内骨外骨肉瘤病.方法 2009年3月解放军第三○九医院收治的胸膜腔骨外骨肉瘤1例,并结合文献报道的6例胸膜腔内骨外骨肉瘤病例的临床特点、影像学和病理组织学资料进行分析.结果 患者男,47岁,因胸闷、气短1月余入院.左侧胸腔后下部有一巨大软组织肿块影,自左后肋膈角区向上延升至左肺门后方,形态不规则,体积约为10.9 cm×9.2 cm×17.7 cm,密度不均匀,有坏死囊变区和多发钙化灶,钙化灶成团聚集在肿块中央区,以肿块下部为著.手术切除肿瘤组织,镜下可见肿瘤性骨样组织,诊断为骨外骨肉瘤.结论 胸膜腔内骨外骨肉瘤是罕见的软组织高度恶性肿瘤,起病隐袭.主要表现为胸腔内巨大软组织影伴广泛钙化灶,钙化灶呈棉絮状或光芒状的高密度影.本病须与发生在胸腔和纵隔的胸膜结核、恶性问皮瘤伴钙化和胸骨骨肉瘤等其他疾病相鉴别.     

Liposarcoma of the stomach： A rare case report

Liposarcoma is the most common soft tissue sarcoma and accounts for 15%-20% of all mesenchymal malignancies. The tumor occurs most frequently in the limbs, retroperitoneum and rarely has a visceral location. We report a case of a gastric liposarcoma in a male patient. A 68 years old male patient was admitted to hospital for abdominal discomfort and fullness lasting for a month. He reported rare episodes of vomiting. The CT examination revealed a large epigastric mass （8 cm × 4 cm） involving the lesser curvature of the stomach, in contact with the pancreas and gallbladder. Fatty areas within the mass were evident. A total gastrectomy together with cholecystectomy was performed. The histopathological diagnosis was a well differentiated liposarcoma. The patient did not undergo any adjuvant treatment, he is under close follow up and two years later he is disease free. We report this case due to the rarity of this tumor in the stomach （nine cases reported in the literature）.     

Asymptomatic localized pleural amyloidosis mimicking malignant pleural mesothelioma: report of a case

We herein report an asymptomatic 65-year-old male with localized pleural amyloidosis mimicking malignant pleural mesothelioma. He had a history of exposure to asbestos and was admitted for investigation of an abnormal pleural thickness detected by chest radiography. Positron emission tomography showed elevation of standardized uptake value corresponding to the pleural thickness. Partial pleurectomy including the tumor was performed for the purpose of diagnosis and local disease control. The pathological examination showed that the tumor was pleural amyloidosis. The tumor was diagnosed as localized primary amyloidosis, because serum monoclonal protein concentration did not increase. Pleural amyloidosis should be considered as a differential diagnosis from pleural mesothelioma.     

Giant primary liposarcoma of the stomach: a case report

Liposarcoma is the most common soft tissue sarcoma and accounts for 15%–20% of all mesenchymal malignancies. The tumor occurs most frequently in the limbs, retroperitoneum and rarely has a visceral location. We report a case of a gastric liposarcoma in a male patient who was admitted to hospital for abdominal discomfort and feeling fullness lasting for a month. The CT examination revealed a giant epigastric mass (36 cm × 34 cm) involving the wall of the stomach. A subtotal gastrectomy together was performed. The histopathological diagnosis was a myxoïd liposarcoma. The patient did not undergo any adjuvant treatment. He was under close follow up and nine months after surgery he represented with tumor recurrence. We report this case due to the rarity of this tumor in the stomach (fifteen cases reported in the literature).     

胸腔内注入顺铂联合滑石粉治疗恶性胸腔积液疗效比较

目的 探讨胸腔内注入顺铂（DDP）联合滑石粉治疗恶性胸腔积液的疗效。方法 病理确诊的恶性胸腔积液58例,经胸腔插管引流术排除胸水后,随机分为二组,开始均胸腔内注入80mg顺铂,治疗组（A组,30例）1周后重复一次,并注入3％滑石粉混悬液100ml;对照组（B组,28例）1周后使重复一次,观察疗效、生活质量、生存率及毒副反应。结果 治疗组总有效率80％,较对照组46％,差异有显著性（P〈O．01）。治疗组0．5、1年的生存率分别高于对照组,差异有显著性。结论 胸腔内联合注入DDP和滑石粉治疗恶性胸腔积液是一种有效的、经济的、副反应少的方法。     

胸膜孤立性纤维性肿瘤10例临床病理观察及文献复习

目的探讨胸膜孤立性纤维性肿瘤(SFT)的临床病理特征,提高对其临床及病理改变的认识。方法对10例胸膜SFT的临床资料和组织学形态进行回顾性分析,并采用免疫组织化学染色(Envision法)研究其形态及免疫表型特点。结果 10例患者中,男性6例,女性4例,发病年龄47~76岁,平均57.5岁。肿瘤分别位于脏层胸膜(4例),壁层胸膜(4例),叶间裂(2例),患者多因咳嗽,胸痛,胸膜腔肿块,肺部肿块就诊。影像学多显示:占位性病变和软组织团块影,其中2例显示有胸腔积液。病理组织学显示:肿瘤界限清晰,由交替性分布的细胞丰富区及稀疏区组成,部分可有粘液变。免疫组织化学显示:梭形细胞表达Bcl-2、CD34和vimentin。结论 SFT是一种较为少见的间叶性梭形细胞肿瘤,好发于胸膜。其确诊主要依赖于病理组织形态学及免疫组织化学染色。完整的手术切除是临床治疗SFT的必要手段,但少数SFT生长活跃,具有侵袭性,需长期随访。     

Discrete pleural nodules associated with a parasternal mass: an unusual manifestation of tuberculosis

SUMMARY: The case presented describes an unusual appearance of thoracic tuberculosis with multiple pleural nodules associated with a parasternal mass as depicted on computed tomography. The patient is a 22-year-old woman who presented with pleuritic chest pain, a left parasternal mass, and weight loss. The pleura of the left hemithorax was studded with multiple low-attenuation, rim-enhancing nodules, and a left parasternal mass with similar imaging features was seen anterior to an enlarged left internal mammary lymph node. There were no pulmonary parenchymal changes nor any mediastinal or hilar lymphadenopathy. Cytologic examination of the specimen obtained with fine needle aspiration of the pleural and parasternal masses yielded granulomatous inflammation. The symptoms remitted with antituberculous chemotherapy and a follow-up CT obtained 6 months later showed complete resolution of the pleural nodules and parasternal mass and considerable regression of the left internal mammary lymph node. Involvement of the pleura with discrete nodules in the absence of parenchymal changes or mediastinal lymphadenopathy is rare in tuberculosis. To the best of the present authors' knowledge, the combination of a tuberculous parasternal mass and multiple pleural nodules as the sole manifestations of thoracic tuberculosis has not been reported previously.     

两种不同方法对结核性胸腔积液的诊疗观察

目的研究胸腔镜联合胸腔闭式引流结合的方法与传统胸腔穿刺抽液联合胸膜活检对大量结核性胸腔积液的临床诊疗效果。方法抽取100例大量结核性胸腔积液病例,将其分为A、B两组,每组50例。分别采用反复胸腔穿刺抽液联合胸膜活检(A组)与胸腔镜联合胸腔闭式引流(B组)联合的方法进行处理。结果 B组患者的诊断率及临床好转率明显高于A组。经过治疗后的体温恢复正常和胸水控制所需的时间明显短于A组;治疗过程中的实际胸水抽放量明显多于A组;胸膜粘连包裹发生率及胸膜增厚发生率明显低于A组;结论胸腔镜与胸腔闭式引流结合的方法对胸腔积液的诊治是简单、快速、有效、安全。     

Setting up a specialist pleural disease service

The past decade has seen a dramatic rise in clinical and research interests in pleural disease in parallel with rising incidences of pleural cancers and infection worldwide. Development of specialist pleural services can streamline patient diagnosis and therapy, reduce health‐care resource consumption, improve procedural training and safety and facilitate clinical research. Pleural ultrasound, pleuroscopy, indwelling pleural catheter services and pleural procedural education programmes for junior staff are important elements of most specialist pleural units. An integrated service including radiology, pathology, oncology and thoracic surgery input is pivotal to success. Establishing funding support and referral sources are the common initial hurdles. This article provides an overview of the need for specialist pleural disease units, the essential elements required and the likely challenges encountered in setting a service up.