Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
POSTER SESSION 2 – P2.04: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC MALIGNANCIES
ESOPHAGEAL CANCER AND OTHER MALIGNANCIES –
TUESDAY, DECEMBER 6, 2016
P2.04-035 SURGICAL PERPLEXITIES IN A RARE CASE OF
SYMPTOMATIC MEDIASTINAL LYMPHANGIOMA
Kingsfield Ong, Keerthi Rajapaksha, Aneez Ahmed
Tan Tock Seng Hospital, Singapore/Singapore
Background: Mediastinal lymphangiomas are very rare and are often
found in close proximity to vital structures of the head and neck. Thus,
the surgical approach can be challenging. It is debatable to employ open
surgery techniques via a trap-door incision or median-sternotomy in attempt
to achieve complete surgical resection for a benign lesion. We report a
case of symptomatic mediastinal lymphangioma that was successfully
managed with a Video Assisted Thoracoscopic Surgery (VATS) approach.
Methods: A 28-year-old female with no significant past medical history was
found to have a superior mediastinal mass on a chest radiograph whilst
undergoing investigations for acute left-sided upper back pain. Computed
tomography (CT) study of the thorax revealed a large lobulated soft tissue
mass in the left superior mediastinum, extending to the supraclavicular
region, measuring approximately 4.4 x 4.9 x 7.4 cm, encasing the left
carotid, subclavian and vertebral arteries, and the left internal jugular and
brachiocephalic veins. Ultrasound guided core biopsy was inconclusive.
Results: The patient underwent surgery via left VATS approach. Frozen
section of the lesion revealed partial lymphoid infiltrates and scattered
cystic-like spaces. No atypical cells or malignancy was seen. Maximal
debulking of the lesion was performed with the aid of bipolar diathermy and
harmonic ultrasonic energy devices instead of a complete resection. The
patient made an uneventful recovery and was discharged home on the first
post-operative day. Histological examination showed lymphoid aggregrates
and dilated lymphatic spaces with a rim of smooth muscle that are typical of
lymphangiomas. She remained well and pain free at her 1yr follow-up clinic.
Conclusion: In conclusion, due to the unique nature and characteristics of
mediastinal lymphangiomas, pre-operative diagnosis and treatment are
challenging. Minimally invasive techniques for maximum debulking are useful
for symptomatic treatment as complete resection may not always be possible.
Keywords: video assisted thoracoscopic surgery, lymphangioma
Conclusion: Primary dedifferentiated liposarcoma of the mediastinum is
extremely rare. Chemotherapy and radiotherapy seems to be ineffective;
radical surgical resection represents the best therapeutic modality. A closed
and long-term follow-up is required because of the high risk of recurrence.
Keywords: mediastinum, liposarcoma
POSTER SESSION 2 – P2.04: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC MALIGNANCIES
ESOPHAGEAL CANCER AND OTHER MALIGNANCIES –
TUESDAY, DECEMBER 6, 2016
POSTER SESSION 2 – P2.04: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC MALIGNANCIES
ESOPHAGEAL CANCER AND OTHER MALIGNANCIES –
TUESDAY, DECEMBER 6, 2016
P2.04-036 GIANT PRIMARY DEDIFFERENTIATED LIPOSARCOMA
OF THE ANTERIOR MEDIASTINUM: AN EXTREMELY RARE
OCCURRENCE
Luigi Ventura 1 , Letizia Gnetti 2 , Cesare Braggio 1 , Valeria Balestra 1 , Paolo
Carbognani 1 , Enrico Maria Silini 2 , Michele Rusca 1 , Luca Ampollini 1
1 Department of Surgical Sciences, Thoracic Surgery, University Hospital of Parma,
Parma/Italy, 2 Pathological Anatomy and Histology, University Hospital of Parma,
Parma/Italy
Background: To present an extremely rare case of giant primary
dedifferentiated liposarcoma of the anterior mediastinum. Methods: A
70-year-old male presented for persistent dyspnoea. Chest CT-scan showed a
huge well-defined solid mass with a fatty tissue component in the
anterosuperior mediastinum (Fig.1A). The tumour caused a wide displacement
of the right lung and mediastinal organs with no signs of invasion. PET-CT scan
showed a unique uptake of the mediastinal mass (Suv max=4.6). A surgical
resection was proposed. A right emiclamshell incision was performed. On
exploration, a huge mass of the anterior mediastinum causing the compression
of the right lung, pericardium and great vessels was observed; no sign of
adjacent organs invasion was found. The tumour was radically resected and the
patient was discharged uneventfully after 6 days. The patient denied any
adjuvant therapy. No evidence of recurrence has been identified as of 16 months
postoperatively. Results: Macroscopically, the smooth, lobulated, well
demarcated, yellowish-white mass weighed 2102g and measured 27x23x13cm
(Fig.1B). Microscopically, the tumour presented a dedifferentiated component
characterized by spindle cells organized in a fascicular pattern with abundant
stroma and necrosis (Fig.1C) and a second component of lipoma-like welldifferentiated
liposarcoma (Fig.1D). Figure 1E showed both components. The
spindle cells displayed a moderate degree of nuclear atypia, with moderate to
marked levels of pleomorphism and cellularity. The spindle cells resulted
positive for desmin and SMA and had an elevated proliferative index
(Ki67=50%) (Fig.1F). Immunohistochemically, tumour cells of both components
were positive for CDK4 (Fig.1G) MDM2 (Fig.1H) and negative for myoglobin,
EMA, S-100. Given that, a final pathological diagnosis of primary
dedifferentiated liposarcoma of the mediastinum was disclosed.
P2.04-037 SOLITARY FIBROUS TUMOR OF THE PLEURA
ASSOCIATED WITH SEVERE HYPOGLICEMIA: THE DOEGE-POTTER
SYNDROME
Luigi Ventura 1 , Letizia Gnetti 2 , Cesare Braggio 1 , Paolo Carbognani 1 , Michele
Rusca 1 , Enrico Maria Silini 2 , Luca Ampollini 1
1 Department of Surgical Sciences, Thoracic Surgery, University Hospital of Parma,
Parma/Italy, 2 Pathological Anatomy and Histology, University Hospital of Parma,
Parma/Italy
Background: to present an extremely rare case of Doege-Potter Syndrome
(DPS). Methods: a 66 years-old man, non-smoker, was admitted for
disorientation and confusional state. Blood tests showed a severe
hypoglycemia (30 mg/dl); the patient was not diabetic and did not take
antihyperglycemic agents. An extremely low values of insulin and C-peptide ​
was also found. A chest CT-scan showed a 20x16cm lobulated mass occupying
the right hemithorax (Figure 1A). FDG-PET showed a unique uptake of the
lesion (SUVmax 2.5). After a multidisciplinary discussion, a surgical resection
was proposed. The lesion of pleural origin was radically resected through a
right posterolateral thoracotomy. From the 1st postoperative day, the blood
glucose levels were normal; the patient was discharged on the 5th
postoperative day uneventfully. Results: the mass measured 26x18x12cm,
presented polylobate margins, elastic consistency and grayish-white color
(Figure 1B). Microscopically, a mesenchymal neoplasm characterized by
spindle cells with moderate atypia, hyperchromasia and nuclear
pleomorphism, organized in a fascicular pattern was found (Figure 1C). A
moderate deposition of collagen extracellular matrix, with areas of hyaline
involution and foci of necrosis was evident (Figure 1D). The mitotic index was
9x10 HPF. Immunohistochemically, tumor cells were positive for CD34, CD99,
BCL-2, vimentin, desmin, IGF1-R, IGF-2, Ki67 (15%) and negative for EMA,
smooth muscle actin, cytokeratin pool, c-kit, DOG-1, myogenin, calretinin,
S100. Considering these histopathologic features, a diagnosis of malignant
solitary fibrous tumor of the pleura was made. After 18 months, the patient is
in good condition and free of disease.
S534 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017