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47 years old, male Complaints: chest pain and cough for 15 days

47 years old, male Complaints: chest pain and cough for 15 days. -History: -lung tuberculosis (20 years ago) -Smoking: -50 pack-years -Family history: -uncle: brain tumor (ex). Laboratory.

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47 years old, male Complaints: chest pain and cough for 15 days

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  1. 47 years old, male • Complaints: chest pain and cough for 15 days

  2. -History: -lung tuberculosis (20 years ago) -Smoking: -50 pack-years -Family history: -uncle: brain tumor (ex)

  3. Laboratory • CBC and routine biochemical laboratory tests were within normal limits. • Sedimentation rate: 28 mm/h • Sputum ARB: negative (3 times)

  4. Respiratory Function Test • FVC: 3.95 L (%100) • FEV1: 3.04 L (%97) • FEV1/FVC: 77 (%96)

  5. CHEST X-RAY

  6. What do you want to do? • A. Thorax CT • B. PET-CT • C. Bronchoscopy • D. Antibiotherapy and follow up • E. Sputum Mycobac. tuberculosis culture

  7. What do you want to do? • A. Thorax CT • B. PET-CT • C. Bronchoscopy • D. Antibiotherapy and follow up • E. Sputum Mycobac. tuberculosis culture

  8. Predominant radiologic pattern? • A. Consolidation • B. Atelectasia and consolidation • C. Atelectasia • D. Mass lesion • E. Interstitial infiltration

  9. Predominant radiologic pattern? • A. Consolidation • B. Atelectasia and consolidation • C. Atelectasia • D. Mass lesion • E. Interstitial infiltration

  10. THORAX CT • Several lymph nodes smaller than 1.5 cm in aorticopulmonary window • Sequela changes and bullous formations at bilateral apical zones • Paranchymal consolidation accompanied with atelectasis located in left upper lobe anterior and lingula

  11. Findings revealed mass lesion derived from lingula, and postobstructive pneumonia

  12. What we should do now? • A. PET-CT • B. Continue to antibiotherapy and radiologic control • C. FOB • D. Sputum cytology • E. Wait for the sputum culture results

  13. What we should do now? • A. PET-CT • B. Continue to antibiotherapy and radiologic control • C. FOB • D. Sputum cytology • E. Wait for the sputum culture results

  14. Upper left lobe was almost totally obstructed with a mass derived from lingula that extended to upper division and narrowed upper division enterance by %80. And, the lesion was mobile Bronchoscopy

  15. What is your diagnosis? • A. Endobronchial PNET • B. Hamartoma • C. NSCLC • D. Carcinoid tumor • E. Endobronchial metastasis

  16. What is your diagnosis? • A. Endobronchial PNET • B. Hamartoma • C. NSCLC • D. Carcinoid tumor • E. Endobronchial metastasis

  17. What is your diagnosis? • A. Endobronchial PNET • B. Hamartoma • C. NSCLC • D. Carcinoid tumor • E. Endobronchial metastasis

  18. PNET: Most common sites of origin are bone and soft tissue In the children and young adults *PNETs that arise in the lung parenchyma are rare! Case Reports Primitive Neuroectodermal Tumor of the Lung 6th case… Kahn AG. Arch Pathol Lab Med—Vol 125, March 2001

  19. Karsinoid tm

  20. Endobronchial metastases • A rare form of lung metastatic disease is endobronchial metastases, most commonly seen with breast, kidney and colorectal cancer.

  21. Hamartoma • Benign lung tumors • Fat and cartilage tissue • Incidence: 0.025%-0.32% • 1.4 % of hamartomas had an endobronchial location

  22. AJR, 1994

  23. Treatment? • A. Bronchotomy • B. Rigid bronchoscopy-laser • C. Rigid bronchoscopy-electrocotery+criyotherapy • D. Flexible bronchoscopy-electrocotery and/or argon koa. • E. Follow-up

  24. Bronchotomy • B. Rigid bronchoscopy-laser • C. Rigid bronchoscopy-electrocautery + cryotherapy • D. Flexible bronchoscopy-electrocautery and/or argon coagulation • E. Follow up

  25. Bronchotomy • B. Rigid bronchoscopy-laser • C. Rigid bronchoscopy-electrocautery + cryotherapy • D. Flexible bronchoscopy-electrocautery and/or argon coagulation • E. Follow up

  26. *Resection of giant endobronchial hamartoma by electrocautery and cryotherapy via flexible bronchoscopy *Sedat Altın ve ark **Kaya S ve ark Endobronchial hamartoma removed by flexible fiberoptic bronchoscopy via electrocautery Indian J Chest Dis Allied Sci. 2006

  27. Endobronchial hamartoma, argon • Uskul BT, Baran R, Turan FE, Sogukpinar O, Aksoy F, Turker H. Endoscopic removal of a chondromatous hamartoma by bronchoscopic electrosurgical snare and argon plasma coagulation. Monaldi Arch Chest Dis. 2007 Dec;67(4):238-40. • Ferreira D, Almeida J, Parente B, Moura E Sá J. [Complete resection of endobronchial hamartomas via bronchoscopic techniques, electrosurgery by Argon plasma and laser]. Rev Port Pneumol. 2007 Sep-Oct;13(5):711-9. Review.

  28. Therapy • Argon plasma coagulation and criyotherapy were performed by using flexible bronchoscopy. Total procedure time was 75 minutes.

  29. Chest X-ray after endobronchial treatment

  30. POSTTREATMENT

  31. TEŞEKKÜRLER

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