Liposarcoma originating in the thoracic cavity is not common. It has been reported that neither chemotherapy nor radiotherapy is effective, and that surgical resection is the only therapeutic option. There have been several cases reported of a large liposarcoma compressing adjacent organs such as the lung and the heart. In such cases, careful management is required to prevent adverse cardiopulmonary events during resection. Here we report a rare case of a 52-year-old male who had a giant liposarcoma occupying the majority of the right thorax. The patient was placed in the supine position, and the tumor was resected through an anterior thoracotomy. Percutaneous cardiopulmonary support (PCPS) was prepared in case of need. However, we succeeded in resecting the huge tumor without use of PCPS. We were unable to completely resect the tumor because it originated from the posterior mediastinum and extended into the left thorax. The resected tumor weighed 3,500 g and was 28 cm in largest diameter. The postoperative course was uneventful, except for hypoxemia lasting a few days caused by re-expansion edema in the lung. The patient was discharged and is alive at five years to date.
We report a case of thymic carcinoma with massive pericardial effusion in a 74-year-old man. This patient with dyspnea was referred to our hospital because of pericardial effusion detected by echocardiography. A chest computed tomography and magnetic resonance imaging showed an anterior mediastinal mass measuring 8.0 x 5.0 cm with massive pericardial effusion. The mass lesion was suggestive of thymic carcinoma or invasive thymoma. Initially, he underwent pericardial drainage. The collected fluid was serous and yellow, and cytological examination found no malignant cells. The tumor with partial pericardium was resected. Histopathological findings confirmed the lesion to be squamous cell carcinoma of the thymus. The etiology of a massive nonmalignant pericardial effusion associated with thymic carcinoma warrants further studies. The patient is alive without recurrence and without pericardial effusion at 3 years to date after the operation. Not all pericardial effusion associated with thymic cancer involves malignant effusion.
The differential diagnoses for primary or metastatic pulmonary malignant lesions are often difficult. We used the patterns of some genetic alterations as a discrimination marker of multiple lung lesions. A 61-year-old Japanese woman underwent total thyroidectomy for the left thyroid cancer in 2004. The next year, she underwent a partial mastectomy for the right breast cancer without pathological nodal invasions. As postoperative treatment, she had radiotherapy with 50Gy for local controls, and was treated with sequential chemotherapy by orally uracil and tegaful. After eight months, chest computed tomography (CT) by follow-up revealed two small nodules in the left lower lobe (the segments of S9 and S10, 10mm and 8mm, respectively). We clinically diagnosed those lesions as metastatic lung cancer from treated the malignant lesions. She underwent partial pulmonary resections by using video assisted thoracoscopic approach for the malignant lesions on December 4, 2006. A nodule in the segment of S10 was pathologically diagnosed as primary lung cancer, but another nodule in the segment of S9 was pathologically diagnosed as poorly differentiated adenocarcinoma. Especially the S9 nodule morphologically was not able to judge by microscopic examination, whether primary lung cancer or metastatic lesions from the treated breast cancer. DNAs were extracted from paraffin-embedded tissue from each of the tumor. Direct sequencing analysis of p53 gene from exons 5-8 using genomic DNA and K-ras from codon 12 were performed for the differential diagnoses. A different pattern of the distribution of p53 mutation in the two nodules was observed, and a same pattern of the distribution of p53 mutation was observed in the DNA samples of the S9 nodule and the treated breast cancer. The mutation was C to T pointmutation in codon 213 on the two lesions. However, K-ras mutation was not detected in each of the tumor sample. So, we diagnosed the S9 nodule as metastatic pulmonary carcinoma from the treated breast cancer on the result of p53 mutation analyses. When we especially need to differentiate between primary and metastasis for the diagnoses of multiple lung lesions, it is useful that the patterns of some genetic alterations are analyzed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.