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Journal ArticleDOI

Pulmonary carcinosarcoma initially presenting as invasive aspergillosis: a case report of previously unreported combination

29 Jan 2010-Diagnostic Pathology (BioMed Central)-Vol. 5, Iss: 1, pp 11-11

TL;DR: A case of primary carcinosarcoma of the lung concurrently occurring with invasive pulmonary aspergillosis in a 66-year old patient is described.

AbstractCarcinosarcoma of the lung is a malignant tumor composed of a mixture of carcinoma and sarcoma elements. The carcinomatous component is most commonly squamous followed by adenocarcinoma. The sarcomatous component commonly comprises the bulk of the tumor and shows poorly differentiated spindle cell features. Foci of differentiated sarcomatous elements such as chondrosarcoma and osteosarcoma may be seen. Aspergillus pneumonia is the most common form of invasive aspergillosis and occurs mainly in patients with malignancy, immunocompromizing or debilitating diseases. Patients with Aspergillus pneumonia present with fever, cough, chest pain and occasionally hemoptysis. Tissue examination is the most reliable method for diagnosis, and mortality rate is high. We describe a case of primary carcinosarcoma of the lung concurrently occurring with invasive pulmonary aspergillosis in a 66-year old patient.

Topics: Aspergillosis (59%), Carcinosarcoma (56%), Sarcoma (54%), Pneumonia (53%), Carcinoma (53%)

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Citations
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Journal ArticleDOI
TL;DR: The use of flexible bronchoscopy has great value in the diagnosis of inhalational injury without any complications and its use should be incorporated into clinical practice.
Abstract: Background As acute inhalational injury is an uncommon presentation to most institutions, a standard approach to its assessment and management, especially using flexible bronchoscopy, has not received significant attention.

41 citations


Cites background or methods from "Pulmonary carcinosarcoma initially ..."

  • ...The incidence of respiratory failure is significant after inhalational injuries, with hypoxemia, pneumonia, and respiratory failure with prolonged ventilatory support and extended hospitalizations being common [1-4]....

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  • ...Table 2 Groups of patients graded according to depth of mucosal damage estimated by fiberoptic bronchoscopy on admission, in line with Chou’s classification [3]...

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Journal ArticleDOI
TL;DR: 2 cases of endobronchial pulmonary carcinoid tumor with superimposed Aspergillus colonization are described, both of which have the possibility of "scar carcinoma."
Abstract: We describe 2 cases of endobronchial pulmonary carcinoid tumor with superimposed Aspergillus colonization. The Aspergillus hyphae were associated with fibrin, ulcer debris, and granulomatous inflammation in part masking the carcinoid tumor. Presence of necrotic debris made diagnosis on biopsy difficult, and atypical carcinoid could not be ruled out. The association of carcinoid tumor with aspergillosis is rare and has been reported in 4 other cases thus far. A review of the literature reveals at least 35 cases of lung carcinoma with coexisting Aspergillus upon presentation. Most of these carcinomas are either cavitary squamous cell or adenocarcinomas harboring an aspergilloma. The other carcinomas are associated with bronchial obstruction as in carcinoids or are a minor component of a preexisting cavity raising the possibility of "scar carcinoma." As in aspergillomas not associated with carcinoma, upper lobe involvement predominates. Diagnosis can be challenging with delayed discovery of underlying neoplasm leading to suboptimal treatment.

22 citations


Cites background from "Pulmonary carcinosarcoma initially ..."

  • ...A review of the literature revealed 35 cases of noncarcinoid primary lung carcinomas with coexisting Aspergillus at the time of the initial diagnosis (Table 2A-D) [9-39], about half of them in nonEnglish journals....

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  • ...There are also scattered case reports of aspergillosis associated with pulmonary carcinomas at the time of primary diagnosis including 4 carcinoid tumors [5-39]....

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Journal ArticleDOI
TL;DR: A 51-year-old Asian female initially manifested with signs of severe anemia who presented with a lung mass unrelated to pleura that was morphologically typical EMC, with strong immunoreactivity for vimentin and NSE after resection, and the anemia was cured.
Abstract: Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft-tissue sarcoma, which primarily occurs deep in the extremities, especially in skeletal muscle, or tendon. EMC of the pleura has been described, however, no case of primary EMC arising from lung has been previously reported. We describe herein, a 51-year-old Asian female initially manifested with signs of severe anemia who presented with a lung mass unrelated to pleura that was morphologically typical EMC, with strong immunoreactivity for vimentin and NSE. Two weeks after resection, the anemia was cured. The patient continued with follow-up, without sign of abnormality 32 months after operation. The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2882199847396682

20 citations


Journal ArticleDOI
TL;DR: Two cases of carcinosarcoma are reported in a 68-year-old patient and a 78-year old patient explored for lung masses, consisting in adenosquamous carcinoma with osteosarcomA in one case and adenocarcinoma with chondrosarcomas in the other case.
Abstract: Carcinosarcoma is an uncommon malignant biphasic tumor that accounts for less than 1% of all lung cancers. It is defined by coexisting histologic elements of carcinomatous and sarcomatous components. We report two cases of carcinosarcoma in a 68-year-old patient and a 78-year-old patient explored for lung masses. Macroscopically, the resected tumors were 7 and 10 cm in diameter. Histologically, they consisted in adenosquamous carcinoma with osteosarcoma in one case and adenocarcinoma with chondrosarcoma in the other case.

19 citations


Cites background from "Pulmonary carcinosarcoma initially ..."

  • ...When heterologous sarcoma elements such as cartilage or skeletal muscle are present, it is easier to confirm the biphasic nature of the tumor, although immunostains can be of further help such as Myogenin and Myo D1 for rhabdomyosarcoma, smooth muscle actin and desmin for leiomyosarcoma, and S100 for chondrosarcoma (3)....

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  • ...Pulmonary carcinosarcoma is a rare and highly malignant lung neoplasm characterized by a biphasic histopathological pattern consisting of both epithelial and sarcomatous components (1-6)....

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  • ...Diaconita reported eight cases among 3,000 patients with malignant pulmonary tumors (3)....

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  • ...Biopsy of the tumor, especially when centrally located, often shows only one component, and peripheral tumors are difficult to reach endoscopically (3,6,7)....

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  • ...More than 90% of the patients have a history of heavy smoking (3)....

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References
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Journal ArticleDOI
TL;DR: A set of research-oriented definitions for the IFIs most often seen and studied in immunocompromised patients with cancer is proposed and three levels of probability are proposed: "proven," "probable," and "possible."
Abstract: During the past several decades, there has been a steady increase in the frequency of opportunistic invasive fungal infections (IFIs) in immunocompromised patients. However, there is substantial controversy concerning optimal diagnostic criteria for these IFIs. Therefore, members of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group formed a consensus committee to develop standard definitions for IFIs for clinical research. On the basis of a review of literature and an international consensus, a set of research-oriented definitions for the IFIs most often seen and studied in immunocompromised patients with cancer is proposed. Three levels of probability are proposed: "proven," "probable," and "possible." The definitions are intended for use in the context of clinical and/or epidemiological research, not for clinical decision making.

2,269 citations


"Pulmonary carcinosarcoma initially ..." refers methods in this paper

  • ...In retrospective microbiology studies of patients with “proven” and “probable” invasive aspergillosis based on the European Organization for Research and Treatment of Cancer, and the Mycosis Study Group of the National Institute of Allergy and Infectious Diseases criteria between 1993-2003, only 1 of a total of 13 patients who met the criteria for invasive aspergillosis was found to have lung cancer [10-12]....

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Book
20 Sep 2004
TL;DR: This book will not become a unity of the way for you to get amazing benefits at all, but, it will serve something that will let you get the best time and moment to spend for reading the book.
Abstract: It sounds good when knowing the pathology and genetics of tumours of the lung pleura thymus and heart in this website. This is one of the books that many people looking for. In the past, many people ask about this book as their favourite book to read and collect. And now, we present hat you need quickly. It seems to be so happy to offer you this famous book. It will not become a unity of the way for you to get amazing benefits at all. But, it will serve something that will let you get the best time and moment to spend for reading the book.

1,845 citations


Journal ArticleDOI
TL;DR: The incidence of aspergillosis is increasing and should be considered in the setting of progressive pulmonary infiltrates in leukemic and other heavily immunosuppressed patients who respond poorly to antibacterial therapy.
Abstract: From 1964 to June 1971, 93 cases of aspergillosis were encountered at Memorial Sloan-Kettering Cancer Center. The 29 cases diagnosed in 1969–1970 and the 15 cases diagnosed in the first half of 1971 represented, respectively, a doubling and a quadrupling since 1964–1965. The incidence of aspergillosis in patients with leukemia was seven times greater than in patients with Hodgkin's disease or lymphoma (p 3 ). Pulmonary involvement was present in 90 of 93 cases, disseminated disease in 23. The commonest clinical pattern was unremitting fever and development of pulmonary infiltrates despite broad-spectrurh antibiotic therapy. In an increasing number of cases aspergillosis followed Pseudomonas aeruginosa infections. When present, serum aspergillus precipitins correlated well with invasive disease, but a negative test result was far less reliable. In one case of acute myelogenous leukemia the patient recovered from pulmonary aspergillosis after surgical excision of the lesion and remission of her leukemia. The incidence of aspergillosis is increasing and should be considered in the setting of progressive pulmonary infiltrates in leukemic and other heavily immunosuppressed patients who respond poorly to antibacterial therapy. Earlier diagnosis may lead to more effective therapy.

503 citations


"Pulmonary carcinosarcoma initially ..." refers result in this paper

  • ...The typical tissue reaction in aspergillus pneumonia is known to be hemorrhagic infarction with a sparse inflammatory infiltrate [13], and our case revealed similar features....

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Journal ArticleDOI
TL;DR: There is significant interest in combination antifungal therapy pairing an echinocandin with either an azole or amphotericin B formulation as therapy for invasive aspergillosis, and there has been an increased understanding of the immunology of Aspergillus infection.
Abstract: Filamentous fungi (moulds) are ubiquitous soil inhabitants whose conidia are inhaled into the respiratory tract, where they may cause life-threatening infections. Among these infections is invasive aspergillosis, which is a major cause of morbidity and mortality in the severely immunocompromised. Risk factors for invasive aspergillosis include prolonged and severe neutropenia, hematopoietic stem cell and solid organ transplantation, advanced AIDS, and chronic granulomatous disease. Invasive aspergillosis most commonly involves the sinopulmonary tract reflecting inhalation as the principal portal of entry. Chest computed tomography scans and new non-culture-based assays such as antigen detection and polymerase chain reaction may facilitate the early diagnosis of invasive aspergillosis, but have limitations. Reflecting an important unmet need, there has been a significant expansion in the antifungal armamentarium. The second-generation triazole, voriconazole, was superior to conventional amphotericin B as primary therapy for invasive aspergillosis, and is the new standard of care for this infection. There is significant interest in combination antifungal therapy pairing an echinocandin with either an azole or amphotericin B formulation as therapy for invasive aspergillosis. In addition, there has been an increased understanding of the immunology of Aspergillus infection, paving the way to novel immune augmentation strategies in animal models that merit evaluation in phase I clinic trials.

292 citations


"Pulmonary carcinosarcoma initially ..." refers background in this paper

  • ...It most often presents as aspergillus pneumonia and almost always involves immunoecompromized or debilitated patients with underlying malignancy [9]....

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  • ...Risk factors include prolonged and severe neutropenia, hematopoietic stem cell and solid organ transplantation, advanced AIDS, and chronic granulomatous disease [9]....

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Journal ArticleDOI
Abstract: 7 Laboratoire d'Epidemiologie et de SantePublique, Faculted e Medecine, UniversiteLouis Pasteur, Strasbourg, France (See the editorial commentary by Kohno on pages XXX-XX) Background. Invasive aspergillosis is associated with high death rates. Factors associated with increased mor- tality have not yet been identified in a large population of patients with various underlying conditions. Methods. We retrospectively reviewed 385 cases of suspected or documented aspergillosis that occurred during a 9-year period. We identified 289 episodes that fulfilled the criteria for possible, probable, or proven invasive aspergillosis according to the international definition criteria and that was treated with an anti-Aspergillus active antifungal drug. Clinical and microbiological variables were analyzed for their effects on overall and attributable mortality. Significant variables in univariate analysis were introduced into a multivariate Cox model. Results. Twelve-week overall and disease-specific survival rates were 52.2% (95% confidence interval, 46.5%- 57.9%) and 59.8% (95% confidence interval, 54.0%-65.4%), respectively. Receipt of allogeneic hematopoietic stem cell or solid-organ transplant, progression of underlying malignancy, prior respiratory disease, receipt of corti- costeroid therapy, renal impairment, low monocyte counts, disseminated aspergillosis, diffuse pulmonary lesions, pleural effusion, and proven or probable (as opposed to possible) aspergillosis are predictors of increased overall mortality. Similar factors are also predictors of increased attributable mortality, with the following exceptions: pleural effusion and low monocyte counts have no impact, whereas neutropenia is associated with a higher attributable mortality. Conclusions. Identification of predictors of death helps in the identification of patients who could benefit from more-aggressive therapeutic strategies. Initiation of therapy at the stage of possible infection improves out- come, and this finding calls for the development of efficient preemptive strategies to fill the gap between empirical and directed therapy.

291 citations


"Pulmonary carcinosarcoma initially ..." refers background or methods in this paper

  • ...In retrospective microbiology studies of patients with “proven” and “probable” invasive aspergillosis based on the European Organization for Research and Treatment of Cancer, and the Mycosis Study Group of the National Institute of Allergy and Infectious Diseases criteria between 1993-2003, only 1 of a total of 13 patients who met the criteria for invasive aspergillosis was found to have lung cancer [10-12]....

    [...]

  • ...renal impairment, low monocyte counts, disseminated aspergillosis, diffuse pulmonary lesions, pleural effusion, and proven or probable aspergillosis [11]....

    [...]