Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy:A case report

BACKGROUND Phyllodes tumours(PTs)are fibroepithelial breast tumours,which can be classified as benign,borderline or malignant,according to their histological characteristics.While various huge borderline or malignant PTs have been previously described,a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported.In order that doctors may have a comprehensive understanding of super-giant benign PTs(≥20 cm),we also performed a literature review to summarize the clinical features,differential diagnosis,and treatment of this disease.CASE SUMMARY A 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass,measuring approximately 30 cm×25 cm×20 cm that was first noticed 1 year previously.A region of skin ulceration and necrosis(20 cm×15 cm)was observed on the lateral side of the mass.Computed tomography(CT)of the chest revealed a pulmonary nodule,which initially suggested a diagnosis of metastasis.CT showed that the boundaries between the pectoralis major and the mass were blurred,which was presumed to be due to tumour invasion.However,two core needle biopsies of the mass showed no evidence of malignancy.Following these results,the tumour was removed by mastectomy of the right breast.Interestingly,postoperative pathology finally proved the diagnosis of a benign PT.After 1 year of follow-up,wedge resection of the small pulmonary nodule was performed,and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer.The patient recovered very well without any postoperative treatment.CONCLUSION This case is unique in that the giant breast mass initially mimicking a malignantclinical presentation was eventually pathologically confirmed to be a benign PT,which misled the diagnosis and complemented the atypical features of benign PTs.The pathological and immunohistochemical results were important in the differential diagnosis.In addition,total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs,especially in large breast masses.In the literature,almost one-half of super-giant benign cases were thought to be malignant tumours before surgery.This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.

Primary pulmonary plasmacytoma accompanied by overlap syndrome:A case report and review of the literature

BACKGROUND Extramedullary plasmacytoma(EMP)is a rare kind of soft tissue plasma cell neoplasm without bone marrow involvement;this type of plasma cell neoplasm involves a lack of other systemic characteristics of multiple myeloma.Primary pulmonary plasmacytoma(PPP),with no specific clinical manifestations,is an exceedingly rare type of EMP.Because of its complexity,PPP is often difficult to diagnose,and there is no report in the literature on cases accompanied by overlap syndrome(OS).CASE SUMMARY A 61-year-old woman without a familial lung cancer history was admitted to our hospital in 2018,for intermittent cough,expectoration,and a stuffy feeling in the chest for 50 years;these symptoms appeared intermittently,especially occurred after being cold,and had been aggravated for the last 10 d.She was diagnosed with pulmonary fibrosis and emphysema,bronchiectasis,OS,and autoimmune hepatic cirrhosis in 2017.A pulmonary examination revealed rough breath sounds in both lungs;other physical examinations found no obvious abnormalities.A routine laboratory work-up showed decreased haemoglobin,increased ESR,and abnormal GGT,ALT,Ig G,γ-globulin,κ-light chain,λ-light chain,rheumatoid factor,and autoimmune antibodies.Emission computed tomography demonstrated abnormally concentrated 99 m Tc-MDP.Chest computed tomography revealed a soft tissue mass in the middle and lower lobes of the right lung.After right middle and inferior lobe resection with complete mediastinal lymph node dissection,immunohistochemical analysis revealed an isolated pulmonary plasmacytoma.The patient received chemotherapy for more than 1.5 years and remains in good general condition.CONCLUSION PPP is a type of EMP,and we report an exceedingly rare presentation of PPP accompanied by OS.

EVALUATION OF STAGING AGREEMENT BETWEEN CTNM AND PTNM FOR LUNG CANCER

A series of 225 consecutive lung cancer patients were prospectively randomized into a study group (75 patients) and a control group (150 Palients), and the agreement between CTNM (clinical staging) and PTNM (pathological staging) was evaluated. Radical mediastinal lymph node dissection was performed and on an average 11.5 nodes were dissected each case in the study group.Only suspected metastatic lymph nodes, 3.4 on an average,were dissected each cast in the coutrol group. CTNM classification was made according to clinical examination,chest image exainination and bronchoscopy in every patient and PTNM staging was made after thoracotomy.Then the agreement of CTNM and PTNM staging was judged by Kappa value. The results showed that the Kappa value in the two groups was lower than the effective standard value of 0.4, which was poorer in the study groul, (KaPPa=4).097) than that in thecontrol group tKappaed.371). The Principal influencing cause was that N was not well evaluated by CTNM. The priucipal manifestation of the staging iuconsistency was that the stage of PTNM was advanced than that of CTNM. In the study group 43% of patients showeil an increased stage and this occurred in 33% of the control group (P< 0.05).The results of the study show that at present the CTNM staging has not fully satisfied the necds of practice and requires to be further improved. The operative procedure that only suspected involved mediastinal lymph nodes are dissected can not meet the needs of PTNM staging. In order to make PTNM staging accurately and evaluate the results of treatment for lung caucer, radical mediastinal lymph node dissection should be performed in every operable Patient.

Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery （LVRS） can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms. Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups. Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO2, PaCO2, dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B. Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded the surgical indication for tumor patients.

Inflammatory myofibroblastic tumor in lung with osteopulmonary arthropathy

Inflammatory myofibroblastic tumor （IMT） is a rare disease that usually occurs in the lung. Recently,several reports have suggested that IMT is a true neoplasm rather than a reactive lesion. By definition, it is composed of spindle cells （myofibroblasts） with variable inflammatory component, hence the name is IMT. We report a patient of inflammatory myofibroblastic tumor in lung with osteopulmonary arthropathy.

CT virtual bronchoscopy: imaging method and clinical application

To evaluate the imaging method and clinical application of CT virtual bronchoscopy (CTVB) Methods Fifty two patients with bronchial and pulmonary diseases were studied with CTVB All patients underwent fiberoptic bronchoscopy and patients with lung cancers were confirmed pathologically Lung cancer of center type was found in 46 patients, postoperative lung cancer in 4, tracheal adenoidcystic carcinoma in 1, and bronchial diverticulum in 1 CTVB was performed using Navigator Smooth software on the workstation(Advantage Windows 3 1, GE Medical Systems) Source images included slice thickness of 3?mm or 5?mm, pitch of 1 0 or 1 5, 1 0?mm or 2 0?mm interval (overlap more than 60%) reconstruction Results CTVB could reveal vividly the tracheo^bronchial lumens, the cartilage rings, the carina and the left and right main bronchi, down to the fourth order of bronchial orifices, mimicing fiberoptic bronchoscopy Among 46 patients with lung cancers of center type, fiberoptic bronchoscopy showed the masses in 45 patients and CTVB displayed the masses in 42 The sensitivity of CTVB was 93 3% and its accuracy was 93 5% (χ 2=1 33, 0 10< P <0 25) The tumors appeared as masses or nodules, causing bronchial stenosis (n=35) or occlusion (n=7). The bronchial rings near the masses were blurred, smooth or absent in contrast to the findings of fiberoptic endoscopy Postoperative bronchial stump (n=4) appeared to be smooth Bronchial diverticulum exhibited a local concavity on CTVB and local protrusion on surface shadow display (SSD) CTVB could pass through the stenotic bronchi and detect the occlusive bronchi from the distal end Conclusions The sensitivity of CTVB in detecting bronchial masses was higher than that of fiberoptic bronchoscopy Combined with multiplanar reconstruction (MPR) and CTVB can demonstrate the extraluminal extension of tumors As a noninvasive examining method, however, CTVB is limited to observe mucosal abnormalities and to obtain histologic samples