US QUIZ FEBRUARY 2022
Case Report A 44-year-old female patient presented in the last 8 months with non-productive cough and occasional right chest pain that worsened with lateral decubitus. Her past medical history was remarkable for uterine leiomyosarcoma that underwent surgery, chemotherapy and radiotherapy 8 years ago. She reported occupational exposure to acrylic compounds for 20 years and active smoking (about 2 pack-year for 4 years). Thoraco-abdomino-pelvic CT revealed a large atypical lesion (82x68x46mm) in the left pulmonary lower lobe, central topography, with invasion of the posterior mediastinal fat and no cleavage plane with the esophagus, and small homolateral pulmonary hilar adenopathies. It was considered more likely to be a primary pulmonary lesion (Fig. 1). Subsequent bronchoscopy identified a bulging of the posterior segmental bronchus wall of the left lower lobar bronchus with normal-looking mucosa. Transbronchial needle aspiration, distal biopsies and bronchial brushing were performed but histopathological results were not conclusive. The EUS evaluation identified, in topography concordant with station 8 of the mediastinum to the left of the aorta, a hypoechoic and heterogeneous lesion with well-defined limits measuring 40x44mm, without calcifications or vascular invasion, with loss of interface with the esophageal wall. Fine needle biopsy (FNB) using a 22G needle was performed (3 passes; 22G Acquire, Boston Scientific) obtaining material that was sent for histocytologic evaluation, nucleic acid amplification test for M. tuberculosis and microbiological examination (Fig. 2). Quiz Discussion Histocytological analysis identified a neoplasm composed of spindle cells with moderate to severe pleomorphism and hyperchromatic nuclei arranged in a fascicular pattern. The neoplastic cells were positive […]
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