대한흉부영상의학회 Weekly Chest Cases

Case No : 302 Date 2003-08-09

Courtesy of Seo Hyun Kwak, M.D., Kyung Soo Lee, M.D. / Samsung Medical Center, Sungkyunkwan University School of Medicione, Seoul, Korea
Age/Sex 50 / F
Chief ComplaintCough and dyspnea

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary artery Leiomyosarcoma (angiosarcoma)
Radiologic Findings: Posteroanterior chest radiograph shows a lobular right hilar mass. Contrast ?enhanced CT scan shows that the mass is low attenuation lesion and fills the main and right pulmonary artery extending into adjacent pulmonary parenchyme of right upper lobe. Gd-enhanced MR image shows enhancing mass filling right pulmonary artery and adjacent right upper lobe after intravenous administration.
Brief Review: Primary leiomyosarcomas occur in the mediastinum, heart and lung. Although they are reported to arise from mediastinal structures such as the esophagus or mediastinal vasculature, including the pulmonary artery and superior vena cava, most mediastinal tumors do not involve these structures. Leiomyocarcomas is one of the more common histologic subtupes of sarcoma to occur in the lung.
Pulmonary artery leiomyosarcomas occur with an equal frequency in men and women, usually a decade or so younger(mean age at diagnosis of 50 years). Patients with pulmonary artery sarcomas present with chest pain, Dyspnea, or intractable congestive heart failure. Primaroy pulmonary leiomyosarcomas are often asymptomatic, but patients can present with hemoptysis. At Radiologic analysis, these neoplasms manifest in the lung as well-marginated smooth or lobular homogeneous nodules or large necrotic masses. This lesion are usually large neoplasms that are often heteromeneous in appearance due to necrosis or hemorrhage within the masses. Because leiomyosarcomas of the pulmonary artery frequently grow within the lumen, they can be difficult to distinguish from pulmonary artery thrombi. MR images can often be useful in establishing the diagnosis because leiomyosarcomas, unlike thrombi, enhance after intravenous administration of gadolinium contrast material.
References: 1. Gregory WG, Bradley MS, Reginald FM, et al. Promary thoracic sarcomas. Radiographics 2002;22:621-637
Keywords: Vascular, Malignant tumor,

No. of Applicants : 25

▶ Correct Answer : 15/25, 60.0%

- Annecy Hospital, France Gilles Genin
- Chonnam National University Hospital, Korea Seok Kyun Chung
- CHU Brabois, Nancy, France Julien Mathias
- CHU Nancy-Brabois, France Denis Regent
- Chungju Hospital Konkuk University, Korea Chang Hee Lee
- CIM Saint Dizier, France JC Leclerc
- Dankook University Hospital, Korea Lee In Sun
- Ewha Womans University MokDong Hospital, Korea Yookyung Kim
- Gwang-myoung Sung-Ae hospital, Korea Jiyong Rhee
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Kangbuk Samsung Hospital, Korea Semin Chong
- MD anderson cancer center, TX, USA Jeong-Geun Yi
- Seoul National University Hospital, Korea Jung-Gi Im
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Ulsan university hospital, Korea Yu-Ri Kahng

▶ Semi-Correct Answer : 4/25, 16.0%

- Incheon Sarang Hospital, Korea Jung Hee Kim
- EPM-UNIFESP and Fleury Medical Center, Brazil Gustavo Meirelles
- MH(CTC), Pune, India Vivek Sharma
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 302 Date 2003-08-09

Discussion

No. of Applicants : 25