Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Primary pulmonary lymphoepithelioma-like carcinoma misdiagnosed as lung squamous cell carcinoma:A case report

BACKGROUND Primary pulmonary lymphoepithelioma-like carcinoma(PPLELC)is an uncommon subtype of squamous cell carcinoma(SCC)of the lung,closely associated with Epstein-Barr virus(EBV)infection.The pathological features of PPLELC closely resemble those of SCC,which makes it prone to misdiagnosis.Surgical intervention constitutes the primary treatment approach for PPLELC.CASE SUMMARY This report describes a 44-year-old woman who was hospitalized for 1 mo due to left chest pain.Computed tomography revealed a mass shadow in the anterior basal segment of the left lower lobe,and a subsequent needle biopsy suggested SCC.The patient underwent radical tumor resection in the lower left lobe of the lung,and postoperative pathological examination indicated lymphoepithelial carcinoma,and the test for EBV encoded small RNA was positive.Following surgery,the patient was scheduled to receive four cycles of adjuvant chemotherapy,using the paclitaxel+carboplatin regimen,but the patient refused further treatment.CONCLUSION PPLELC is an exceptionally rare subtype of lung SCC and is prone to misdiagnosis.

Imaging findings of primary pulmonary synovial sarcoma with secondary distant metastases:A case report

BACKGROUND Synovial sarcoma(SS)accounting for 6%-10%of primary soft tissue malignancies mainly occurs in deep soft tissue adjacent to joints of the limbs.Primary pulmonary SS(PPSS)is rare and has a poor prognosis.Cases of secondary distant metastases of PPSS occur rarely and there is a lack of corresponding imaging reports.We summarized the imaging findings of PPSS with multiple metastases confirmed by surgery and pathology,and shared valuable information on PPSS.CASE SUMMARY A 43-year-old female patient had a solid space occupying lesion in the right upper lobe of the lung.The results of a hemogram,erythrocyte sedimentation rate(ESR)and tumor markers were all within the normal range,tuberculin skin test(5 TU PPD)was negative(-).Chest computed tomography examination showed similar round soft tissue density in the posterior segment of the right upper lobe.Thoracoscopic-assisted wedge resection of the right upper lobe of the lung,right upper lobe resection and lymph node dissection were performed.Nine months after surgery,ultrasound examination showed multiple metastases on the chest wall and kidney.CONCLUSION PPSS is a rare malignant lung tumor with strong invasiveness,early distant metastasis and poor prognosis.There are very few imaging reports.PPSS is often manifested as irregular tumor and calcification,and the metastases have extremely low echo on ultrasonography.Contrast-enhanced ultrasound indicates that the arterial phase of tumor metastases shows rapid centripetal high enhancement,manifested as“fast forward and fast regression”.

Primary pulmonary meningioma:A case report and review of the literature

BACKGROUND Primary pulmonary meningioma(PPM)is a rare disease that is usually benign.The most common presentation of PPM is isolated pulmonary nodules or masses,so the disease can mimic any other lung tumor on imaging,especially lung cancer or metastasis.CASE SUMMARY A 47-year-old asymptomatic woman presented with a well-defined,lobulated pulmonary mass with calcification in the left lower lobe.The mass measured 69 mm×57 mm×61 mm and was found during a chest computed tomography(CT)performed for physical examination.Contrast-enhanced CT and positron emission tomography(PET)/CT revealed mild enhancement of the mass,with accumulation of 18-fluoro-2-deoxy-D-glucose(18F-FDG).Transbronchial biopsy suggested a provisional diagnosis of low-grade neuroendocrine tumor.Subsequent enhanced head magnetic resonance imaging revealed no positive lesions.An open cuff resection of the left lower lobe and wedge resection of the lingual segment were performed.Histopathological and immunohistochemical examination revealed that the mass was a PPM.CONCLUSION PPM should be considered in the differential diagnosis of isolated pulmonary masses found incidentally on CT and should be diagnosed based on a combination of radiological and histological features.Surgical resection is currently the main treatment strategy.No recurrence of benign PPMs has been reported after complete resection.

Solitary primary pulmonary synovial sarcoma:A case report

BACKGROUND Synovial sarcoma(SS)is an uncommon and highly malignant soft tissue sarcoma in the clinic,with primary pulmonary SS(PPSS)being extremely rare.Here,we describe the clinical characteristics,diagnosis,and treatment of a solitary PPSS case confirmed via surgical resection and fluorescence in situ hybridization(FISH).CASE SUMMARY A 33-year-old man was admitted because of intermittent coughing and hemoptysis for one month,with lung shadows observed for two years.Wholebody positron emission tomography-computed tomography(PET-CT)revealed a solitary mass in the upper lobe of the right lung,with uneven radioactivity uptake and a maximum standardized uptake value of 5.6.The greyish-yellow specimen obtained following thoracoscopic resection was covered with small multinodulated structures and consisted of soft tissue.Hematoxylin and eosin staining revealed spindle-shaped malignant tumor cells.Immunohistochemistry indicated these tumor cells were CD99 and BCL-2-positive.Furthermore,the FISH test revealed synovial sarcoma translocation genetic reassortment,which confirmed the diagnosis of SS.CONCLUSION PPSS is extremely rare and tends to be misdiagnosed as many primary pulmonary diseases.PET-CT,histologic analysis,and FISH tests can be used to differentiate PPSS from other diseases.Surgical resection is regularly recommended for the treatment of solitary PPSS and is helpful for improving the prognosis.

CONSOLIDATIVE PRIMARY PULMONARY LYMPHOMA: THREE MISDIAGNOSED CASES

Objective: To investigate the clinical features and the reason of misdiagnosis of consolidative primary pulmonary lymphoma. Methods: Retrospective study was conducted for three cases with consolidative primary pulmonary lymphoma(PPL). The relevant literatures of primary pulmonary lymphoma in recent years were also reviewed. Results: All patients had been misdiagnosed for a long time due to the non-specific clinical features. Conclusion: Consolidative PPL is difficult to diagnose and is misdiagnosed frequently in clinic. Definitive diagnosis of PPL requires an adequate biopsy specimen. The most important prognostic factor is the histology.

Development and validation of a CT-based radiomics model for differentiating pneumonia-like primary pulmonary lymphoma from infectious pneumonia: A multicenter study

Background:Pneumonia-like primary pulmonary lymphoma(PPL)was commonly misdiagnosed as infectious pneumonia,leading to delayed treatment.The purpose of this study was to establish a computed tomography(CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia.Methods:In this retrospective study,79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled.Patients from center 1 to center 7 were assigned to the training or validation cohort,and the remaining patients from other centers were used as the external test cohort.Radiomics features were extracted from CT images.A three-step procedure was applied for radiomics feature selection and radiomics signature building,including the inter-and intra-class correlation coefficients(ICCs),a one-way analysis of variance(ANOVA),and least absolute shrinkage and selection operator(LASSO).Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model.Two radiologists reviewed the CT images for the external test set.Performance of the radiomics model,clinical factor model,and each radiologist were assessed by receiver operating characteristic,and area under the curve(AUC)was compared.Results:A total of 144 patients(44 with pneumonia-like PPL and 100 infectious pneumonia)were in the training cohort,38 patients(12 with pneumonia-like PPL and 26 infectious pneumonia)were in the validation cohort,and 73 patients(23 with pneumonia-like PPL and 50 infectious pneumonia)were in the external test cohort.Twenty-three radiomics features were selected to build the radiomics model,which yielded AUCs of 0.95(95%confidence interval[CI]:0.94-0.99),0.93(95%CI:0.85-0.98),and 0.94(95%CI:0.87-0.99)in the training,validation,and external test cohort,respectively.The AUCs for the two readers and clinical factor model were 0.74(95%CI:0.63-0.83),0.72(95%CI:0.62-0.82),and 0.73(95%CI:0.62-0.84)in the external test cohort,respectively.The radiomics model outperformed both the readers’interpretation and clinical factor model(P<0.05).Conclusions:The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia,which might provide assistance for clinicians in tailoring precise therapy.

Primary Ovarian Small Cell Carcinoma of Pulmonary Type: Analysis of 6 Cases and Review of 31 Cases in the Literatures

Objective Primary ovarian small cell carcinoma of pulmonary type(SCCOPT)is a rare ovarian tumor with a poor prognosis.The platinum-based chemotherapy is the standard treatment.However,there is little research on the clinical characteristics of SCCOPT and the potential benefits of other treatments due to its low incidence.The study aims to investigate clinicopathological characteristics and treatment of SCCOPT.Methods We summarized the clinical,imaging,laboratorical and pathological characteristics of 37 SCCOPT cases,in which 6 cases were admitted to the Gansu Provincial Hospital from the year of 2008 to 2022 and 31 cases reported in 17 English and 3 Chinese literatures.Results The median age of the studied SCCOPT cases(n=37)was 56.00(range,22-80)years.Almost 80%of them had a stageⅢorⅣtumor.All patients underwent an operation and postoperative chemotherapy.Nevertheless,all cases had a poor prognosis,with a median overall survival time of 12 months.Immunohistochemical y,the SCCOPT of all patients showed positive expressions of epithelial markers,such as CD56 and sex-determining region of Y chromosome-related high-mobility-group box 2(SOX-2),and negative expressions of estrogen receptor,progesterone receptor,vimentin,Leu-7,and somatostatin receptor 2.The tumor of above 80%cases expressed synaptophysin.Only a few cases expressed neuron-specific enolase,chromogranin A,and thyroid transcription factor-1.Conclusions SCCOPT had a poor prognosis.SOX-2 could be a biomarker to be used to diagnose SCCOPT.

Primary pulmonary artery chondrosarcoma： the use of different imaging modalities

Fewer than 300 patients with primary pulmonary artery sarcoma have been reported since 1923,when it was first described by Mandelstamm.1 The diagnosis of pulmonary artery sarcoma is difficult,and misdiagnosis as chronic pulmonary embolism often occurs.Herein,we reported a case of primary pulmonary artery chondrosarcoma.So far as we know,this patient served as the first case ever reported to receive computed tomography pulmonary angiography （CTPA）,gadolinium enhanced magnetic resonance imaging （MRI）,and positron emission tomography/computed tomography （PET/CT） before surgery.By these means,the utility of different imaging modalities for pulmonary artery sarcoma was well demonstrated.Keywords：primary pulmonary artery chondrosarcoma; computed tomography pulmonary angiography;magnetic resonance imaging; positron emission tomography

EFFECTIVENESS OF ELECTROCHEMICAL TREATMENT OF PRIMARY PULMONARY MALIGNANT TUMORS

Electrochemical therapy is a new therapy for the treatment of cancer.From January 1989 to November 1991