Search

Stereotactic body radiation therapy (SBRT) has increasingly been used to treat early-stage primary lung cancers, but its effectiveness and safety in patients with multiple synchronous primary lung tumors is not as well established. Our aim was to evaluate clinical outcomes, patterns of recurrence, and toxicities for these patients.We queried an institutional database of patients treated with SBRT for primary lung tumors from 2007 to 2019. Patients with known metastatic disease were excluded. Recurrences were described as new primaries (NP) if they occurred as an isolated pulmonary mass outside the previous planning target volume.We analyzed 126 lesions from 60 consecutive patients who received SBRT synchronously to ≥2 lesions for nonmetastatic lung cancers. Median total dose per lesion was 50 Gy (range, 30-60 Gy) delivered over 3 to 5 fractions. All but 4 lesions were treated to a biologically effective dose ≥100 Gy. The median follow-up time was 47.3 months (interquartile range, 34.1-65.6). Median overall survival was 46.2 months. Two and 5-year overall survival for all patients was 70% and 48%, respectively. Median progression-free survival was 26 months (interquartile range, 7.6-32.6), and at the time of data collection 25 patients (42%) had experienced any disease progression. Median time to progression was 36 months: 9 (15%) patients experienced local failure, with 1- and 2-year local failure rates of 8% and 13%, respectively. Four patients (7%) experienced regional failure, at 3, 10, 30, and 50 months. Eleven patients (18%) experienced distant failure, with 2-year distant failure rate of 13%. Thirteen patients (21%) developed NPs, with 2-year NP rate of 15.1%. Fourteen patients (23%) experienced Common Terminology Criteria for Adverse Events grade ≥2 toxicity, and 2 patients (3%) experienced Common Terminology Criteria for Adverse Events grade ≥3 toxicity (pneumonitis and hemoptysis).Synchronous SBRT to biologically effective dose ≥100 Gy appears safe and effective for selected patients with synchronous primary lung tumors.

OBJECTIVE To provide updated information on the distribution of histopathologic types of primary pulmonary neoplasia in dogs and evaluate the effect of postoperative adjuvant chemotherapy in dogs with pulmonary carcinoma. ANIMALS 340 dogs. PROCEDURES Medical records of dogs that underwent lung lobectomy for removal of a primary pulmonary mass were reviewed, and histopathologic type of lesions was determined. The canine lung carcinoma stage classification system was used to determine clinical stage for dogs with pulmonary carcinoma. RESULTS Pulmonary carcinoma was the most frequently encountered tumor type (296/340 [87.1%]), followed by sarcoma (26 [7.6%]), adenoma (11 [3.2%]), and pulmonary neuroendocrine tumor (5 [1.5%]); there was also 1 plasmacytoma and 1 carcinosarcoma. Twenty (5.9%) sarcomas were classified as primary pulmonary histiocytic sarcoma. There was a significant difference in median survival time between dogs with pulmonary carcinomas (399 days), dogs with histiocytic sarcomas (300 days), and dogs with neuroendocrine tumors (498 days). When dogs with pulmonary carcinomas were grouped on the basis of clinical stage, there were no significant differences in median survival time between dogs that did and did not receive adjuvant chemotherapy. CLINICAL RELEVANCE Results indicated that pulmonary carcinoma is the most common cause of primary pulmonary neoplasia in dogs; however, nonepithelial tumors can occur. Survival times were significantly different between dogs with pulmonary carcinoma, histiocytic sarcoma, and neuroendocrine tumor, emphasizing the importance of recognizing the relative incidence of these various histologic diagnoses. The therapeutic effect of adjuvant chemotherapy in dogs with pulmonary carcinoma remains unclear and warrants further investigation.

We present a case of an arterio-venous fistula that developed in the early postoperative course after wedge resection of the right upper lobe. A 57-year old male treated for acute myeloid leukemia was referred from the hematology department because of a right upper lobe tumor. Wedge resection was performed. Three weeks later recurrent tumor was visualized on chest X-ray. Angio-CT diagnosed an arterio-venous fistula and the patient was scheduled for redo surgery. Completion upper lobectomy was performed and the pathological examination confirmed iatrogenic arterio-venous fistula. To our knowledge such an early complication has never been reported so far. Iatrogenic intrapulmonary arterio-venous fistulas are very rare. We present a case of such fistula that developed early after wedge resection of the right lung upper lobe tumor and presented as recurrent pulmonary mass. To the best of our knowledge this is the first description of such a case.

INTRODUCTION To optimize CT chest protocol by comparing venous contrast timing with arterial timing for contrast opacification in vessels, qualitative image quality and radiologists' satisfaction and diagnostic confidence in assessing for potential nodal, pleural and pulmonary disease in general oncology outpatients. METHOD Matched case-control study performed following CT protocol update. 92 patients with a range of primary malignancies with 2 CT chests in a 2-year period, one with an arterial phase protocol and the second in the 60 second venous phase, were included. Contrast attenuation in aorta, pulmonary artery and liver were measured. Subjective measurements assessed perivenous artefact, confidence in nodal pleural and pulmonary assessment and presence of pulmonary emboli. Statistical analysis was performed using paired and unpaired t-tests. RESULTS Venous-phase CT demonstrated more consistent enhancement of the vessels, with higher attenuation of the nodes, pulmonary and pleural lesions. There was a significant reduction in perivenous beam hardening artefact on venous-phase CT (P

A 77-year-old female patient consulted our hospital for an abnormal shadow observed on chest X-ray. Computed tomography revealed the shadow of a mass in the right lower lung lobe and two shadows of masses in the pancreatic head and body. 18F-fluorodeoxyglucose-positron emission tomography showed an intense uptake only in the fields corresponding to these three masses. Each mass was diagnosed as leiomyosarcoma by transcutaneous needle biopsy of the pulmonary mass and endoscopic ultrasound-guided fine-needle aspiration of the pancreatic masses. The primary site was the lung because the pulmonary lesion was solitary, and no tumor was found in other organs. In English language literature, a case of primary pulmonary leiomyosarcoma with metastasis solely to the pancreas has not yet been reported to the best of our knowledge.

CASE PRESENTATION: A 57-year-old woman was admitted to our hospital for an abnormal chest shadow found during routine chest radiography. She had no respiratory symptoms. Her medical history included dyslipidemia, and her surgical history included conization for cervical cancer at age 38 years. She was a social drinker and ex-smoker of approximately 10 cigarettes per day (from ages 20 to 30 years); she denied recreational drug use.

Perivascular epithelioid cell tumor (PEComa) is a rare type of mesenchymal neoplasm, which occurs most commonly in uterus and gastrointestinal tract. PEComa with perirenal manifestation is an extremely rare entity. To the best of our knowledge, only four cases have been reported up to now. In this case, we reported a patient with both a pulmonary mass and a perirenal mass. Two resections were performed successively and postoperative pathology suggested pulmonary micro invasive adenocarcinoma (MIA) and perirenal PEComa. This is the first case of perirenal PEComa with pulmonary MIA. Combining the present case and prior literature, we summarized the crucial role of immunohistochemistry in the diagnosis and consider that complete operation might be conducive to patients with perirenal PEComa that presents a benign phenotype, regardless of complications with other tumors.

Diagnosis of anomalous intrathoracic lesions may be challenging and require a multidisciplinary approach. We present a case of granulomatosis with polyangiitis (GPA) clinically and radiologically mimicking metastatic lung cancer with a bilateral pulmonary mass, mediastinal and cervical lymph node involvement, and pleural effusion. Surgical biopsy of the thoracic lesion revealed necrotic granulomatous inflammation, and the final diagnosis was subsequently confirmed by kidney biopsy and biochemical parameters. This case illustrates how comprehensive diagnosis secures timely and relevant treatment. Systemic vasculitis may be one of the key differential diagnoses in patients with multiorgan involvement, especially with pattern-mimicking lung cancer.

Peripheral primitive neuroectodermal tumours are rare tumours in juveniles. The current patient was a paraplegic 8‐month‐old Scottish deerhound with a suspected pulmonary mass. Radiographically, there was a large extrapleural mass within the mid‐left hemithorax. On MRI, the mass was mainly hyperintense on T2‐weighted images, isointense on T1‐weighted images and was heterogeneously strongly contrast enhancing with a multilobulated appearance, spinal cord compression, paraspinal musculature invasion and intrathoracic extension. Those changes were confirmed on post‐mortem, and the mass diagnosed based on immunohistochemistry.

A 2‐year‐old male neutered domestic shorthair cat underwent investigations for acute onset of lethargy, hyporexia, and cough. Computed tomography of the thorax identified a large mass‐like lesion in the left cranial lung lobe and bilateral pleural effusion. Thoracotomy and left cranial lung lobectomy were performed. Histopathology of the pulmonary mass was consistent with a localized Toxoplasma gondii pneumonia, confirmed by positive polymerase chain reaction on the affected lung lobe. After adjunctive medical management with a 28‐day course of clindamycin (12.5 mg/kg PO q12h), clinical signs resolved and repeat thoracic radiographs documented no abnormalities. The cat remains clinically well 1 year after surgery.

A 14-year-old, neutered male domestic shorthair cat presented for acute monoparesis with physical exam findings and biochemical data supportive of a distal arterial thromboembolism. Thoracic radiographs revealed an alveolar pattern in the right middle lung lobe and multifocal nodules in other lung lobes. A pulmonary mass was found on necropsy, which was composed of both carcinomatous and sarcomatous components, confirmed with cytokeratin and vimentin immunohistochemistry. Using the World Health Organization classification scheme for mixed pulmonary tumors, this tumor would be characterized as a pleomorphic squamous cell carcinoma under the umbrella term of pulmonary sarcomatoid carcinoma. The World Health Organization classification of mixed pulmonary tumors and its application to previously reported mixed pulmonary tumors in companion animals is discussed. This is the first reported case of this tumor type in a cat, as well as the first report of this tumor type associated with an arterial thromboembolism in any veterinary species.

Histoplasmoma is a rare form of chronic infection with Histoplasma capsulatum (HC) infection that is frequently misconstrued as malignancy. The diagnosis is invariably through histopathological studies and appropriate staining after surgical resection and carries an excellent prognosis even for lesions more than 3 cm. We present a case of a young female whose clinical presentation and imaging studies were highly concerning for lung malignancy, such as non-Hodgkin′s lymphoma (NHL) in controlled human immunodeficiency (HIV) infection and was resected accordingly. However, on histopathological examination, it was revealed to be a histoplasmoma. There were no signs of disseminated disease; hence antifungal therapy was not administered. The patient remained asymptomatic at outpatient follow-up after a year. Infectious etiology should make the differential list when working up a pulmonary nodule or even a mass inappropriate setting, including well managed immunocompromised conditions. These are potentially treatable causes with an excellent prognosis. It is important to recall that such infections might have atypical presentations in immunocompromised patients, as highlighted in this case.

Giriş : Literatürde Lokal Organize Pnömoni (LOP) ve Lokal Bronşiolitis Obliterans Organize Pnömoni (BOOP) olarak adlandırılan, medikal tedaviye yanıt vermeyen, kesin tanı konulamayan akciğer patolojileri cerrahiye gidebilmektedir. Ülkemizde son yıllarda artan tarama yöntemleri nedeniyle tüberküloz kadar sık olmasa da giderek artan sıklıkta maligniteyle karışan, benign akciğer patolojileri içinde yerini almaktadır. Literatürde nadir olarak saptandığı belirtilmekte ve çok az sayıda makalede küçük vaka serilerinde bahsedilmektedir. Gereç ve Yöntem : Kliniğimizde Ocak 2013- Aralık 2019 arasında toplam 3795 hastaya akciğerde kitle nedeniyle rezeksiyon yapıldı. Bu hastaların 708’ine Wedge rezeksiyon, 2886’sına ise anatomik rezeksiyon yapıldı. Final patolojisi lokal organize pnömoni (LOP) olarak raporlanan 78 hasta incelendi. Bütün hastalar operasyon öncesi anamnez, fizik muayene, yaş, cinsiyet, sigara kullanımı, Toraks BT, PET-BT, bronkoskopi ve SFT ile değerlendirildi. Bulgular ve Tartışma: Final patolojisi LOP olarak raporlanan hastalara cerrahi rezeksiyon olarak, videotorakoskopik veya torakotomi ile wedge (n=49 %63) rezeksiyon ve lobektomi (n=29 %37) uygulanmıştı. Bu hastaların hiçbirinde operasyon öncesi kesin tanısı yoktu. Hastaların yaşları 42 ile 78 (ort.52) arasındaydı. Hastalarda en sık görülen semptom öksürükdü (n=71 %91). Hastaların %91’inde (n=71) 10 paket/yılı aşkın sigara anamnezi mevcuttu. Ek hastalık olarak kronik obstriktif akciğer hastalığı en çok eşlik eden hastalıktı (n=54 %69). Hastaların PET-BT’sinde kitlenin SUV tutulumları 2.8 ile 11.7 (ort.6.7) arasında değişmekteydi. Ortalama lezyon boyutu 4.1 (2.8 ila 7.3) idi. Hastaların hiçbirine postoperatif LOP olması nedeniyle antibiyoterapi ve kortikosteroid tedavisi uygulanmadı. Hiçbir hastada nüks saptanmadı. Ortalama takip süresi 49 aydı. Sonuç: Tanı konulamayan, takiplerde gerilemeyen, sigara anamnezi, hemoptizisi ve radyolojik olarak malignite şüphesi olanlarda cerrahiden kaçınmamak gerekir.

Introduction: Lung is a common place for the spread of tumors from within or other parts of the body. Lung shadows with a diameter less than or larger than 3 cm are termed lung nodule or mass respectively. Aims: To study the histopathological spectrum of lung masses and efficacy of computerized tomography guided FNAC/biopsy in diagnosis of lung masses. Materials and Methods: Forty (40) cases picked up as lung masses on conventional screening & CT scan were subjected to CT guided FNAC/Biopsy and their pathological variations were studied. Results: A total of 40 cases were studied. The mean age of the patients was 60.57 years with 25 (62.5%) males and 15 (37.5%) females. 65% of lesions were in right lung. Malignant lesions were more common and accounted for 27 (67.5 %) cases and benign in 8 (20%) cases. Amongst the malignant lesions, adenocarcinoma was seen in 16 (59.25%), squamous cell carcinoma in 10 (37.03%) and small cell carcinoma in 1 (3.70%) case. Conclusion: FNAC is a simple, relatively safe, rapid, reliable technique for the diagnosis of pulmonary mass lesions, particularly with the aid of computed tomography (CT) scan. FNAC not only distinguishes between benign and malignant lesions but also helps in tumor typing of lung cancer. Keywords: Lung mass, Computed tomography, Needle biopsy.

A 46-year-old asymptomatic woman with a newly detected large pulmonary mass was admitted to our hospital. An ultrasonography-guided needle biopsy was performed based on a suspicion of malignancy, and an ectopic goiter was confirmed pathologically. Laboratory findings were unremarkable, except that thyroid function tests suggested subclinical hyperthyroidism. A 131I whole-body scintigraphy and SPECT/CT were further performed and revealed intense radioiodine uptake in the pulmonary mass, the mediastinal nodule, and thyroid gland. A diagnosis of ectopic pulmonary goiter with normally located thyroid was finally made.

Context: Lung cancer is the most common cancer affecting males worldwide. Its incidence in females is also on an increasing trend. Other conditions affecting lung-like tuberculosis are on a rise in middle-east countries due to overcrowding and poor living conditions. In developing countries, image-guided fine-needle aspiration cytology (FNAC) of lung lesions is a cost-effective method for early detection and apt treatment of patients by physicians. Aim: The main aim of this study is to identify the importance of computed tomography (CT)guided FNAC as an accurate and cost-effective tool in early diagnosis of lung lesions. Settings and Design: It was prospective and retrospective study done in a government medical college of West Bengal, India. Material and Methods: Over a period of two years, 42 cases were included in the study. These were further subjected to evaluation of pulmonary mass lesions by CT guided transthoracic fine needle aspiration cytology. Results: Out of these 42 cases majority were males with cough being most common clinical presentation. On CT guided FNAC of pulmonary lesions 69% of cases were malignant. Cytoradiological correlation in this study was 90.4%. Conclusion: CT guided FNAC of lung lesions is an accurate, cost effective and quick technique for early diagnosis, referral and appropriate treatment of patients in developing countries.

Undifferentiated pleomorphic sarcoma (UPS) was previously known as malignant fibrous histiocytoma (MFH). This sarcoma occurs preferentially in the extremities and retroperitoneal space; primary pulmonary UPS/MFH is rare. We report a 52-year-old woman referred to our hospital with dyspnea and severe cough. Chest computed tomography (CT) revealed a pulmonary mass in the left upper lobe and pleural effusion. Cytology of the effusion showed no malignancy; however, the tumor increased rapidly in size, and the patient’s respiratory symptoms worsened. The tumor occupied almost all of the left upper lobe and involved the adjacent pericardium. She underwent left upper lobectomy with pericardial resection and reconstruction. Postoperative pathology of the resected specimen showed undifferentiated pulmonary sarcoma, pT4N0M1a stage IV A, and genetic analyses revealed the v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. The patient’s dyspnea recurred 1 month postoperatively, and CT showed marked pleural effusion. An 18F-fluorodeoxyglucose positron emission tomography demonstrated abnormal diffuse accumulation of 18F-fluorodeoxyglucose in the left pleural cavity. We initiated five cycles of chemotherapy with doxorubicin and ifosfamide, and the patient has been well without recurrence for 24 months after multidisciplinary treatment with surgery followed by systemic combination chemotherapy. We successfully treated our patient with primary pulmonary UPS/MFH using a multidisciplinary approach, even though this sarcoma carries a poor prognosis and is insensitive to both chemotherapy and radiotherapy.

Background Although bleeding events are the major concern when using oral anticoagulants, intrathoracic hemorrhages due to warfarin are rare. Most cases in the literature have been related to trauma and have manifested as a hemothorax. Here we report a case of a nontraumatic hemorrhage within a pre-existing pulmonary cyst that presented as a lung mass during warfarin therapy. Case presentation A 75-year-old asymptomatic woman presented with a 10-cm-diameter mass on chest radiography that was not evident 6 months prior. She had been taking warfarin for paroxysmal atrial fibrillation and a transient ischemic attack. There was no history of chest trauma, warfarin overdosing, or any suspected interactions with other drugs such as nonsteroidal anti-inflammatory drugs or antibiotics. The prothrombin time/international normalized ratio(PT-INR) was prolonged at 4.73 and her hemoglobin level was 8.7 g/dl. Chest computed tomography(CT)revealed an air-fluid mass adjacent to the right upper and middle lobes with a pleural effusion. A CT scan obtained 15 years prior revealed a cyst at the corresponding site and the mass was diagnosed as a warfarin-related hemorrhage within the pre-existing pulmonary cyst. We performed a surgical resection of the cyst to prevent any worsening hemorrhage and subsequent infection. The postoperative course was uneventful and the patient was discharged on the 3rd postoperative day. Conclusion A warfarin-related thoracic hemorrhage, other than a hemothorax, could manifest as a pulmonary mass on radiography in patients with pre-existing pulmonary cysts. History taking especially of any anticoagulant medications and a precise assessment of the past images are crucial for a correct diagnosis. Once the intrapulmonary cystic hemorrhage becomes evident, prompt withdrawal with a reversal of warfarin and surgical resection are required to prevent a worsening hemorrhage and subsequent infection.

Pulmonary metastasis of an esthesioneuroblastoma is uncommon. In this report, we present a case of an esthesioneuroblastoma pulmonary metastasis in an adult. A 39-year-old man treated with surgical resection of olfactory neuroblastoma was found to have a solitary pulmonary mass on a surveillance computed tomography scan performed 5 years after undergoing primary surgery and radiation treatment. He underwent lobectomy, and histopathology revealed esthesioneuroblastoma metastasis. To our knowledge, no case of esthesioneuroblastoma metastasis presenting as a solitary pulmonary nodule has been described in peer-reviewed literature. Keywords: Esthesioneuroblastoma, Solitary pulmonary nodule, Pulmonary metastasis

Background: The typical non-muscle complications of long-surviving X-linked myotubular myopathy (XLMTM) include scoliosis, head deformity, macrocephaly, gastroesophageal reflux disease and peliosis hepatis. Recently, pulmonary blebs and recurrent pneumothorax have also been reported as uncommon complications, whereas no reports on autopsy cases have focused on lung lesions., Case presentation: An 8-year-old boy with XLMTM presented recurrent pneumothorax requiring bleb resection and pleurodesis. He subsequently developed multiple pulmonary mass lesions. He died of hemorrhagic shock due to peliosis hepatis. Autopsy showed multiple peliosis-like hematomas in the blebs of the lung. The histopathological examination of the hematomas revealed pooled blood without a pathway to bronchus. No apparent increase in desmin- or α-smooth muscle actin (α-SMA)-positive cells, namely myofibroblasts, was observed around hematomas, suggesting that the mutation in the myotubularin gene was involved in the defective repair process in the liver and lung tissues., Conclusion: Recurrent pneumothorax should be considered as a non-muscle complication of XLMTM. Peliosis-like intrapulmonary hematoma may also be a critical complication caused by poor proliferation of myofibroblasts in the tissue repair process.

Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody (ANCA) associated; vasculitis affecting small vessels and mainly cause upper and lower respiratory tract and renal involvement. Urogenital involvement is extremely rare and poorly described in the literature. We report herein a case of a 46-year old immunocompetent patient presenting with recurrent urinary tract infections and bladder retention with incidental findings of sinusitis, and pulmonary mass revealing GPA., Highlights • Genito-urinary disease is rare in granulomatosis with polyangiitis patients, reported in

Background: Lung malignancy is the most common cause of death in the developed countries. Male to female ratio is 3:1. Consumption of Tobacco upsurges the rate of evolving lung cancer by 30 folds. Other risk factors include repeated exposure to aspects like carcinogens, asbestos, pulmonary fibrosis and radiotherapy. Aim of Study: The aim of this study is to assess the role of diffusion weighted magnetic resonance imaging in charac-terization of pulmonary masses. Patients and Methods: This study was carried out on forty (40) patients 8 females and 32 males who had Pulmonary mass on the X-ray or CT chest and aged above 18 years old. All the studied patients underwent to detailed history taking, laboratory studies and radiological examination using MRI (GE 1.5 Tesla) using body phased-array Coil and DWI (b-value 0, 500, and 800s/mm2). Results: Thirty lesions were malignant, and 10 lesions were benign. The malignant masses showed significantly higher signal intensity on DWI than benign masses (p

Objective: Cerebral air embolism (CAE) is an extremely rare but serious complication of pigtail catheter drainage. The aim of the case report is to review our experience in the diagnosis and treatment for CAE after pigtail catheter drainage.Case presentation: In our study, we report a case of CAE following pigtail catheter insertion for pneumothorax. A 50-year-old man was diagnosed with a pulmonary mass in the right lower lobe. He underwent a right lower lobectomy. Pneumothorax was present after the removal of the chest tube. Pigtail catheter drainage was used in order to treat the pneumothorax, which resulted in convulsions, limb stiffness, and unconsciousness. A brain CT scan was immediately performed and showed multiple low densities in the right occipital lobe, which was diagnosed as CAE. Assisted breathing, antibiotic treatment, and antiepileptic therapy were used and the patient gradually improved and was discharged at 27 days of treatment but the muscle strength of the left limb was weakened.Conclusion: We analyzed and summarized the possible causes of CAE in the literature, and the findings of the case could enhance the vigilance of clinicians.

Authors discuss novel approach to the management of fetal congenital pulmonary cystic malformation (CPAM) and possible benefit of routine administration of betamethasone, which is currently recommended only for severe cases. The article presents authors' own experience with antenatally diagnosed CPAM and describes 4 cases of prenatally diagnosed CPAM without hydrops treated by two doses of betamethasone at 21-31 weeks of gestation with the aim of improving the perinatal prognosis by effect on not only mortality but also postnatal morbidity. Article also summarizes current knowledge on all aspects of the prenatal CPAM focusing on its treatment options. Data were obtained from the literature search based on the PubMed and Scopus database with additional search of particular articles from reference list of the selected publications.All 4 patients from the case reports showed regression of the pulmonary mass after maternal administration of betamethasone with 100 % survival rate. Even though it is not possible to say if the CPAM regression was due to the betamethasone treatment, we did not observe any complication in relation to the treatment and all cases survived until discharge. During the literature search, we did not find any data on betamethasone administration in non-hydropic fetuses with CPAM in relation to the overall perinatal and postnatal morbidity, neither data comparing the outcome between the treated versus observed only fetuses.Routine betamethasone treatment should be discussed in antenatally diagnosed CPAM cases without fetal hydrops in order to reduce the perinatal morbidity associated with CPAM (Tab. 1, Ref. 47). Keywords: betamethasone, CPAM (congenital pulmonary adenomatoid malformation), fetal therapy.

We report a case of organizing pneumonia, which revealed intense uptake on both 18F-FDG and 68Ga-FAPI (fibroblast activation protein inhibitor) PET/CT. Our findings indicate that organizing pneumonia should be taken into consideration when diagnosing a cancer-like pulmonary mass with intense 68Ga-FAPI uptake.

Introduction: Primary pulmonary paraganglioma is a rare tumor with few cases reported in literature and unspecific clinical presentation.Case Presentation: A 49-year-old woman presented to our department with an incidental finding of a pulmonary mass at chest X-ray and no associated clinical symptom. The CT scan and the FDG-PET showed mild uptake of contrast, but a definitive diagnosis was only possible after surgery through histopathological examination.Conclusion: Paragangliomas originating in the pulmonary tissue are generally non-functioning masses discovered incidentally in otherwise asymptomatic patients. Surgery appears to be the best treatment option, with only radiologic follow-up necessary afterwards.

Highlights • Teratomas are tumours composed by different tissues derived from one or more of the three primitive germ cell layers. The frequency of mediastinal teratomas ranged from 1 to 5 %, in most cases with localization in the anterior/superior mediastinum. • VATS technique is minimally invasive, and it is characterized by a shorter recovery period, a minor blood loss and a shorter hospital stay. VATS has been advocated since 2010 for pulmonary resections, but today it is also performed for mediastinal intervention and a series of reports have demonstrated that it is feasible and safe. • We demonstrate that uniportal VATS could be used also to remove mediastinal giant mass, without complications for patients, with a reduction hospital stay, less post-operative pain and better cosmetic results., Introduction Teratomas are tumours composed by different tissues derived from one or more of the three primitive germ cell layers. The frequency of mediastinal teratomas ranged from 1 to 5 %, in most cases with localization in the anterior/superior mediastinum. Presentation of case We report a case report of a 29 years old male who presented an occasional and asymptomatic mediastinal mass. Computer Tomography (CT) scan showed a 6.8 × 4.5 cm mass in the anterior mediastino, located below the left brachio-cephalic vein, next to aortic arch and left pulmonary artery. Complete excision of the mass “en block” with anterior mediastinal adipose tissue was achieved, using uniportal VATS approach. The postoperative course was regular, without air leak or other pulmonary complication. Discussion VATS technique is minimally invasive and, moreover, it is characterized by a shorter recovery period, a minor blood loss and a shorter hospital stay. VATS has been advocated since 2010 for pulmonary resections, but today it is also performed for mediastinal intervention and a series of reports have demonstrated that it is feasible and safe. Conclusion The report aims at pointing out the possibility of undergoing this kind of surgery not only in case of pulmonary mass (on which the previous literature has focused) but also when mediastinum lesions occur, as in our case.

Background - Blastomycosis is an uncommon fungal infection endemic to certain parts of Eastern North America. Blastomycosis has been reported twice before in ferrets, but both cases died shortly after diagnosis. Case description - Two male neutered ferrets ( Mustela putorius furo ) from the same household, 4 and 1½-years of age, presented for respiratory signs. The diagnostic work-up included thoracic radiographs and ultrasound, advanced imaging, and cytology of a pulmonary mass, which led to a diagnosis of pulmonary blastomycosis in both cases. Both ferrets developed central nervous system (CNS) clinical signs. Ferret 1 developed signs referable to CNS lesions 3 months after initial presentation, and the second ferret 27 months after initial presentation. An MRI study and CSF analysis were performed on the first case. Both ferrets were treated with combinations of antifungal therapy and short-term prednisolone with a total follow-up period of 35 and 31 months respectively. Both cases responded favorably to antifungal therapy and supportive care. Response to therapy and the dynamics of infection were monitored with serial urinary Blastomyces antigen assays, thoracic radiographs, and routine bloodwork. The first ferret was euthanized three years after diagnosis due to an abdominal neoplasia. An exocrine pancreatic carcinoma, a cervical chordoma, and pulmonary blastomycosis were diagnosed on histopathology. Conclusions and case relevance - This report constitutes the first to document CNS blastomycosis in ferrets, long-term medical management of both pulmonary and suspected CNS blastomycosis in ferrets, and the use of serial urinary Blastomyces antigen assays to monitor disease progression in this species.

Highlights • VATS technique is minimally invasive and, moreover, it is characterized by a shorter recovery period, a minor blood loss and a shorter hospital stay. • We speak of “Ectopic thyroid gland” when a piece of thyroid tissue is placed at a certain distance from the second to fourth tracheal cartilages. • This case report aims at describing the successful extraction of a massive piece of ectopic thyroid from a young woman’s body, thanks to uniportal VATS., Introduction We speak of “Ectopic thyroid gland” when a piece of thyroid tissue is placed at a certain distance from the second to fourth tracheal cartilages. Presentation of case This case report focuses on a case of a hyperplastic cystic nodule of ectopic thyroid in a 30-year-old woman treated with uniportal video-assisted thoracic surgery (VATS). The patient, was admitted to Emergency Unit for abdominal pain and vomit, underwent a CT which highlighted a mass of significant dimension on the right side of the mediastinum, in contact with close structures. The lesion has been removed with an innovative mini-invasive technique, which is characterized, differently from traditional surgical approaches, by reduced loss of blood and time of hospitalization and, in addiction to that, an aesthetic small-dimensioned scar. Discussion VATS technique is minimally invasive and, moreover, it is characterized by a shorter recovery period, a minor blood loss and a shorter hospital stay. VATS has been advocated since 2010 for pulmonary resections, but today it is also performed for mediastinal intervention and a series of reports have demonstrated that it is feasible and safe. Conclusion The report aims at pointing out the possibility of undergoing this kind of surgery not only in case of pulmonary mass (on which the previous literature has focused) but also when mediastinum lesions occur, as in our case.

A 70-year-old woman was referred to our hospital after a nodular shadow was noted on chest X-ray. Chest computed tomography showed a pulmonary mass in the right upper lobe, and brain magnetic resonance imaging revealed a right-sided frontal lobe tumor. A histological examination of a transbronchial lung biopsy specimen revealed adenocarcinoma with epidermal growth factor receptor mutations involving both exon 19 deletion and exon 20 insertion. After stereotactic radiotherapy for brain metastasis, the patient was treated with afatinib, which resulted in a complete response. We observed a case in which a patient had non-small cell lung cancer with compound EGFR mutations involving both exon 19 deletion and exon 20 insertion mutations that responded well to afatinib therapy.

Cryptococcosis is an invasive fungal disease that most commonly affects immunocompromised individuals, typically causing pulmonary and central nervous system (CNS) symptoms. The fungus that causes cryptococcosis, Cryptococcus, is globally disseminated and often transmitted through bird droppings. The two most frequent and pertinent species responsible for clinical infections in humans include Cryptococcus neoformans, which has been known to cause the majority of cryptococcosis globally until recently, during which Cryptococcus gattii has been identified and reported more frequently. A 54-year-old male with a history of renal transplant on chronic immunosuppressants and type 2 diabetes mellitus was found to have multiple lung masses within the right upper and right lower lobes. He had also been experiencing syncope, multiple falls, worsening headaches, tinnitus, diplopia, and ongoing weight loss. The patient underwent a percutaneous biopsy of one of the lung masses in addition to a lumbar puncture (LP), both of which revealed positive cryptococcus antigen confirmed to be C. gattii. The patient was started on amphotericin B and flucytosine to treat cryptococcal meningitis. Despite treatment, his condition continued to worsen, necessitating daily therapeutic LP and temporary placement of a lumbar drain. Once his symptoms were better managed, he was discharged from the hospital but has continued to have serial LPs outpatient while concurrently taking fluconazole to prevent reaccumulation of cerebrospinal fluid (CSF) and recurrence of symptoms. This report describes a unique presentation of disseminated C. gattii infection presenting as multiple lung masses and the subsequent management of CNS cryptococcosis.

Background Intracardiac masses are relatively rare but the diagnosis can be challenging for the cardiologist and the clinical presentation can be misleading. While most of the cardiac masses are benign, malignant masses are mostly metastatic tumours. Case summary An 81-year-old man was admitted to the cardiology department for congestive heart failure with the complaint of recent dyspnoea. The initial electrocardiogram was suggestive of a late presentation of an anterior myocardial infarction. Blood test showed mild and stable elevation of troponin and brain natriuretic peptide. Doppler-echocardiography revealed an interventricular septal thickening. Contrast echocardiography revealed a mass with a possibly necrotic centre and peripheral hypervascularization. Cardiac computed tomography (CT) confirmed the existence of a cardiac tumour with a hypodense centre and also revealed the presence of a large tumour of the lung’s left lower lobe with multiple enlarged lymph nodes associated with possible left adrenal gland metastasis. Computed tomography-guided percutaneous biopsy of the pulmonary mass demonstrated a squamous cell lung cancer which was likely the primary cancer. The patient was discharged home waiting for chemotherapy to start but died a few days later at home of an unknown cause. Discussion Diagnosis of intracardiac mass is difficult, often requiring multiple imaging modalities. Contrast-enhanced echocardiography may help early diagnosis and can be easily implemented with other imaging modalities such as cardiac magnetic resonance imaging or CT.

Ewing's sarcoma (ES) is a rare and highly aggressive tumor belonging to a family of neoplasms of neuroectodermal origin, which primarily affects the bones or soft tissues. ES originating from lung parenchyma without chest wall involvement is extremely rare with less than 40 cases reported in the English literature. A 41-year-old man admitted to the thoracic surgery department presenting with intermittent non-productive cough, dyspnea, left-sided chest pain for two months for further evaluation and treatment with a preliminary diagnosis of pulmonary mass. Contrast-enhanced thorax CT and MRI revealed a large heterogeneous soft-tissue mass in the left lower lobe with no distant metastases or occult primary tumor. Following the percutaneous transthoracic biopsy, histopathological and immunohistochemical results were consistent with primary pulmonary ES. Though rare, primary pulmonary ES should be considered in the differential diagnosis of young patients presenting with a large heterogeneous soft tissue mass in the lung. This case report highlights the diagnosis, radiologic and pathologic findings, and management of primary pulmonary ES.