Thakkar Rohan G, Shah Sumeet, Dumbre Amol, Ramadwar Mukta A, Mistry Rajesh C, Pramesh C S
Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Ann Thorac Cardiovasc Surg. 2011;17(4):400-3. doi: 10.5761/atcs.cr.10.01589.
A 43-year-old woman presented to us with progressive breathlessness, dry cough and weight loss. A chest radiograph showed homogeneous opacification of the entire left hemithorax. A contrast enhanced computed tomography (CECT) scan of the thorax showed a large intrathoracic mass occupying almost the entire left hemithorax and appeared grossly inoperable. A transcutaneous CT guided tru-cut biopsy revealed a solitary fibrous tumour. We reviewed the CT scans based on the biopsy report, and, in retrospect, the mediastinal vessels seemed more stretched and pushed by the tumor rather than directly infiltrated by it. We performed an exploratory thoracotomy and to our surprise, were able to dissect the mass quite easily off the mediastinum. She had an uneventful postoperative recovery, and the final histopathology confirmed a solitary fibrous tumor. We report this case to emphasize that a cursory clinico-radiological interpretation can dissuade surgical intervention in these patients.
一名43岁女性因进行性呼吸困难、干咳和体重减轻前来就诊。胸部X线片显示整个左半胸均匀性致密影。胸部增强计算机断层扫描(CECT)显示一个巨大的胸腔内肿块,几乎占据整个左半胸,从大体上看似乎无法手术切除。经皮CT引导下的切割活检显示为孤立性纤维瘤。我们根据活检报告复查了CT扫描,回顾发现纵隔血管似乎更多是被肿瘤牵拉和推移,而非直接受其浸润。我们进行了开胸探查,令我们惊讶的是,能够很容易地将肿块从纵隔分离。她术后恢复顺利,最终组织病理学证实为孤立性纤维瘤。我们报告此病例以强调粗略的临床放射学解读可能会使这些患者放弃手术干预。