1. Primary Pulmonary Sarcoma
Wael Batobara

2. History 78y Caucasian Male presented to ER
9 days SOBE , Dry Cough , Night Sweating
X smoker >50 y ( 10 pack y )
Received 3 days Levofluxacin for ? CAP
No Chest pain , Hemoptysis , Orthopnea or PND
No Leg swelling
No Change in Wt or appetite

3. History PMH : GERD , BPH & Knee OA No contact with similar case
No recent travel
No pets or occupational exposure
NKA
Rx : PRN NSAID , H2 Blocker

4. Examination Afebrile BP 150/90 HR 100 regular
RR 20 Sat 93% on 5 liters O2
No Pallor or Lymphadenopathy
Chest: Central Trachea
Dull percussion Lt Lower 2/3 Post
Absent breath sound Lt L 2/3 post
CVS ,Abd & LL NAD

5. Investigation CBC WBC & Plt  N HB 130 MCV N PTT & INR  N
Lytes ,BUN & Creat  N
LFT , EKG & UA  N
ABG PH PO L O2
PCo HCO3 26
CXR & Chest CT

6. Investigation Pleural Tapping  2.8 liters drained Serosanguinus
exudate
-ve cytology
CT Guided Bx  Spindle Cell Sarcoma
CT Head , Abd & Pelvis N

7. Hospital Course Seen By Thoracic Sx  Inoperable
Seen By Med.Onc.offered Chemo & XRT
Post tap CXR small effusion
Not accessible By US
Improved SOB Sat 94% RA
Discharged Home
F/U Oncology clinic for XRT +/- Chemo

8. Primary Lung Sarcoma Incidence Presenting Symptoms & Signs Diagnosis
Treatment
Prognostic Factors

9. Incidence
Sarcomas are rare malignant tumors arising from the mesenchymal tissues at all body sites and include a wide array of histopathologic types
10,700 newly diagnosed sarcomas per year in the United States {0.80 percent of the 1,334,100 new malignant tumors }
77 percent arise in soft tissue and the remainder in bone
CA Cancer J Clin 2003 Jan-Feb

10. Incidence Primary Lung Sarcoma is Rare { 0.1-1% of all lung cancers}
From 1970 To 1999
In Hospital Louis Pardel 12 Cases
Lung Cancer
From 1982 To 1998
In Lille University Hospital  18 Cases
Euro Jr Of Cardiothoracic Sx

11. Patients Characteristics
Male / Vs /18
Female / Vs /18
Mean age Vs
Smoking 7/ Vs /18
Asymptomatic 1/ Vs /18
Lung Cancer Vs Euro Jr Of Cardiothoracic Sx

12. Symptoms & Signs Chest pain ,SOB & Cough common
Fatigue , Wt loss less common
Supraclavicular LN & Pancoast Syn in 1 Pt
CXR & CT  Solitary masses
Upper Lobe
other features : cavitations ,effusions ,atelectasis
,chest wall & ribs involvements
Lung Cancer & Euro Jr Of Cardiothoracic Sx

13. Bronchoscopy & Pathology
N 8/12 Vs 8/18
Endobronchial lesion 1/12 Vs 7/18
Extrinsic compression 3/12 Vs 3/18
Most common type Leiomyosarcoma 7/12
then monophasic synovial sarcoma 2/12
While in the other study
Malignant Fibrous Histiocytoma 4/18
Undifferentiated Sarcoma 4/18
Lung Cancer & Euro Jr Of Cardiothoracic Sx

14. Diagnosis PET Scan 18 Patients with soft tissue sarcoma
4 Patients with benign soft tissue lesion
100% sensitivity for sarcoma
Uptake correlate with tumor grade
Only one benign lesion showed uptake
Journal of Nuclear Medicine Feb 1996

15. Treatment & Prognosis 9/12 Surgery 6 lobectomies & 3 pneumonectomies
3/12 Inoperable : 1 Pancoast , 1 Age
1 locally advanced disease
3/12 Chemotherapy Ifosamiade containing regimens IVA or IVAD
CA Cancer J Clin 2003 Jan-Feb

16. Treatment & Prognosis 6/12 alive disease free
6/12 died 4 from disease progression
1,3,5 y Survival was 71,50,38 %
Relapse 5/12 4 intrathoracic Rx wit Chemo
CA Cancer J Clin 2003 Jan-Feb

17. Treatment & Prognosis 15/18 Surgery
3/18 pre op Chemo to shrink tumor size
 successful in 2 patients
1 free resection margins
1 microscopic invasion
Euro Jr Of Cardiothoracic Sx

18. Treatment & Prognosis 9/18 died 5 from sarcoma
9/18 alive till now 3 with recurrent disease which was resected in 2
Significant correlation between stage & survival
5 y survival 43%
Euro Jr Of Cardiothoracic Sx

19. Thank You
I hope It Was Not Boring