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TURKISH THORACIC SOCIETY 11 th Annual Congress. LUNG AND PLEURAL MALIGNANCIES GRAND ROUND Prof. Metin GORGUNER, MD gorguner@atauni.edu.tr. 23 – 27 April 2008, Antalya, TURKIYE. General Characteristics. Male, 45 years old Born in the Eleşkirt Living in the Ağrı Goverment official
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TURKISH THORACIC SOCIETY 11th Annual Congress LUNG AND PLEURAL MALIGNANCIES GRAND ROUND Prof. Metin GORGUNER, MD gorguner@atauni.edu.tr 23 – 27 April 2008, Antalya, TURKIYE
General Characteristics • Male, 45 years old • Born in the Eleşkirt • Living in the Ağrı • Goverment official • Back pain at left hemithorax • Admission; 14 Jan 2008
Patient’s Brief History • Back pain at left side during the last 2 months • Various nonspesific therapies • Pain relieving with analgesics Chest X Ray in Nov 2007 Thorax CT in Nov 2007
Patient’s Former History • Pneumonia in 1985 ? • Traffic accident in 1990 • Discal hernia operation in 2000 • Varicose veins of the left leg • Pantoprazol, 40 mg/daily • Smoking, 25 packs-year • No history of familial disease
Physical Examination • Good performance status • A soft, swelling and immobile lesion on the thoracic wall at the leftside • In percussion; dullness of left lower hemithorax • In auscultation; diminished breath sounds of left lower hemithorax
A soft, swelling and immobile lesion on the thoracic wall at the leftside
Laboratory Findings • All of the parameters was normal • except the ESR: 80 mm/hour • Tuberculin skin test was negative • Electrocardigraphy was normal • Mild restriction on PFT
What is your initial diagnosis ? A. Organizing hematoma B. Chest wall cystic lesion C. Pleural tumor D. Chest wall tumor E. Rib tuberculosis
Which test should be performed ? A. Chest X Ray B. Thorax MRI C. Percutaneous Needle Aspiration D. Bronchoscopy E. Surgery
Which test should be performed ? A. Chest X Ray B. Thorax MRI C. Percutaneous Needle Aspiration D. Bronchoscopy E. Surgery
Chest X Ray 29 November 2007 15 January 2008
Chest X Ray 29 November 2007 15 January 2008
Multi Detector CTThree Dimensional Volume Rendering Image
What is your diagnosis ? A. Organizing hematoma B. Chest wall cystic lesion C. Malignant mesothelioma D. Chest wall tumor E. Rib tuberculosis
Which test should be performed ? A. Thorax MRI B. Percutaneous Needle Aspiration D. Bronchoscopy C. Pleural Biopsy E. Surgery
Which test should be performed ? A. Thorax MRI B. Percutaneous Needle Aspiration D. Bronchoscopy C. Pleural Biopsy E. Surgery
What is your final diagnosis ? A. Organizing hematoma B. Chest wall cystic lesion C. Malignant mesothelioma D. Chest wall tumor E. Rib tuberculosis
What is your final diagnosis ? A. Organizing hematoma B. Chest wall cystic lesion C. Malignant mesothelioma D. Chest wall tumor E. Rib tuberculosis
FINAL DIAGNOSIS Mesenchymal Tumor with Mixoid Component (Mixoid Malignant Fibrous Histiocytoma)
MALIGNANT FIBROUS HISTIOCYTOMA Clinical Summary – 1 • A common soft tissue tumor • In late middle age, with a median of 54 yrs • Develops frequently in the extremities and the retroperitoneum. • The lungs are the most common site of metastases. • Primary pulmonary MFH is extremely rare.
MALIGNANT FIBROUS HISTIOCYTOMA Clinical Summary – 2 • Clinical and radiographic features are nonspesific; • Cough, chest pain, hemoptysis, dyspnea • A solitary mass with a nondescript appearance and relatively homogeneous density on CT or MR • Tissue examination is absolutely required.
MALIGNANT FIBROUS HISTIOCYTOMA Pathology • Five histologic subtype; • Pleomorphic • Mixoid • Giant cell • Inflammatory • Angiomatoid