Allen Alexander, Smith Steven C, Pillappa Raghavendra, Boikos Sosipatros, Medalion Benjamin, Grizzard John, Cassano Anthony, Harris Timothy
Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, 401 College Street, Richmond, VA, 23298-0037, USA.
Department of Pathology, Division of Anatomic Pathology, Virginia Commonwealth University School of Medicine, 1200 East Marshall Street, Gateway Building, 6th Floor, Room 205, Box 980662, Richmond, VA, 23298-0662, USA.
Respir Med Case Rep. 2021 Apr 27;33:101414. doi: 10.1016/j.rmcr.2021.101414. eCollection 2021.
Intimal sarcoma (IS) is a rare malignancy arising in the great vessels or heart, most commonly in the pulmonary artery, primarily treated with surgical intervention. We report a case of IS of the pulmonary artery diagnosed after an endarterectomy to remove a suspected pulmonary embolism. The tumor could not be entirely resected and showed interval growth at post-operative follow up. Neoadjuvant radiotherapy was then delivered to improve resectability. Imaging confirmed decreased tumor size, and a surgical resection with pulmonary artery reconstruction and right upper lobectomy was then successfully performed. Adjuvant gemcitabine and docetaxel was later initiated. Four months post-operatively, the patient is alive without disease recurrence. While prior reports in the literature document use of adjuvant chemotherapy and radiotherapy for treatment of IS of the pulmonary artery, no prior experience has documented utility of neoadjuvant radiotherapy for improvement of resectability. Our experience suggests that neoadjuvant radiation should be considered to improve resectability in cases of borderline resectable IS of the pulmonary artery.
内膜肉瘤（IS）是一种罕见的恶性肿瘤，发生于大血管或心脏，最常见于肺动脉，主要通过手术干预进行治疗。我们报告一例在进行动脉内膜切除术以清除疑似肺栓塞后诊断出的肺动脉内膜肉瘤病例。肿瘤无法完全切除，术后随访显示有进展。随后进行了新辅助放疗以提高可切除性。影像学检查证实肿瘤尺寸减小，随后成功进行了肺动脉重建和右上叶切除术的手术切除。后来开始使用吉西他滨和多西他赛进行辅助治疗。术后四个月，患者存活且无疾病复发。虽然文献中先前的报告记录了使用辅助化疗和放疗治疗肺动脉内膜肉瘤，但此前没有经验证明新辅助放疗对提高可切除性有用。我们的经验表明，对于肺动脉交界可切除的内膜肉瘤病例，应考虑采用新辅助放疗以提高可切除性。
