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Pulmonary Pathology
Sunday, March 2, 2008, 7:30 PM
Convention Center 201/203 Unusual Mesenchymal Proliferations
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Moderator:
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DANI ZANDER
Penn State Milton S. Hershey Medical Center
Hershey, PA
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Clinical histories are displayed below.
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Submitted by: Samuel A. Yousem - University of Pittsburgh School of Medicine, Pittsburgh, PA
43-year-old woman with pleuritic chest pain associated with a hemorrhagic pleural effusion, who was found on CT scan to have a pleural based mass with associated diffuse pleural thickening. A pleural biopsy was performed.
Case 1 - Slide 1
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Submitted by: Carlyne D. Cool - University of Colorado Health Sciences Center, Denver, CO
A 56-year-old woman with a past medical history of migraines, coronary artery disease, and depression presented to her primary care physician with complaints of shortness of breath for four months. She developed increasing dyspnea and edema. She was diagnosed with pulmonary arterial hypertension, but continuous intravenous prostacylin therapy failed to alleviate her symptoms, and she died soon after initiating treatment.
Case 2 - Slide 1
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Submitted by: Richard Attanoos - Llandough Hospital, Penarth, South Glamorgan, United Kingdom
A 37-year-old female, previously healthy, presented with a 2-month history of increasing dyspnea. CXR revealed a unilateral pleural effusion, and CT scan showed an effusion, chest wall/pleural mass, and pulmonary infiltrates. At thoracoscopy, the pleura appeared diffusely nodular. She underwent pleural biopsy.
Case 3 - Slide 1
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Submitted by: Megan Dishop - Baylor College of Medicine, TX Children's Hospital, Houston, TX
Newborn boy, twin A, delivered at 28 weeks gestation to a 31-year-old mother with respiratory distress and severe hydrops, requiring intubation, high frequency oscillatory ventilation, and nitric oxide therapy. Maternal history and obstetric history were unremarkable, except for discordant fetal growth (twin A larger, twin B smaller). Chest x-ray showed a hyperinflated right lung and a mass in the right upper lung field, displacing the heart. No pleural or pericardial effusions were detected at delivery. Echocardiogram showed evidence of persistent pulmonary hypertension. He had rapid deterioration despite support and died less than 24 hours after delivery. A similar mass was not detected in Twin B.
At autopsy, the baby was hydropic and non-dysmorphic. The lungs were discrepant in size, with a very large right lung weighing 70 grams (12 grams expected) and a hypoplastic left lung. The right upper lobe was enlarged, covering the anterior mediastinum, and replaced by a firm solid pale tan mass. The right lower lobe was hemorrhagic. No other visceral anomalies were identified.
A section of the right upper lobe is provided.
Case 4 - Slide 1
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Submitted by: Aliya N. Husain - University of Chicago, Chicago, IL
On prenatal ultrasound, this baby boy was found to have a left lung sequestration/mass. There was no other malformation seen. The lesion was resected at 8 weeks of age. The specimen consisted of tan-pink tissue measuring 3.3 x 2.6 x 1.7 cm. Serial sectioning showed multiple cysts varying in size from 0.1 to 0.5 cm.
Case 5 - Slide 1
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