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23.04.2018 | case report | Ausgabe 2/2018

memo - Magazine of European Medical Oncology 2/2018

Pulmonary mass: never judge a book by its cover

Zeitschrift:
memo - Magazine of European Medical Oncology > Ausgabe 2/2018
Autoren:
Inke De haes, Yvan Valcke, Koen Deschepper, Elisabeth Beerens, Pieter Goeminne
Wichtige Hinweise

Notation of prior abstract publication/presentation

This abstract has not been previously published.

Summary

Background

This case shows that a tumor can present in an uncommon way. When dealing with pulmonary masses, tissue remains the most important issue.

Clinical presentation

We present the case of a 71-year-old woman with a mass of more than 10 cm in the left lung. Pulmonary CT scan and PET scan confirmed this with also revealing mediastinal, thoracic and paravertebral invasion, without extrathoracic metastatic lesions. Bronchoscopic evaluation and ultrasound guided transbronchial needle aspiration could not yield a diagnosis. Because of rapid clinical deterioration, new imaging was performed, showing a cavitary lesion with air-fluid level in the tumor. Extensive microbiological work-up remained negative.

Intervention

To yield a pathological diagnosis, we performed a thoracotomy, revealing a polymorphic lymphoid infiltrate with scattered large atypical B-cells infected with Epstein-Barr virus, vasculitis and granulomatosis leading to a diagnosis of Lymphomatoid Granulomatosis. The patient received 6 cycles of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Methylprednisolone), 2 doses of Rituximab monotherapy, 4 doses of intrathecal Methotrexate and consolidation radiotherapy with a complete response.

Conclusion

Lymphomatoid granulomatosis (LYG) is a rare pulmonary disease, which should be included in the differential diagnosis of ‘a pulmonary mass’. This case emphasizes the need for tissue acquisition.

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