대한흉부영상의학회 Weekly Chest Cases

Case No : 796 Date 2013-01-28

Courtesy of Kwang Nam Jin, Youkyung Lee / Seoul Metropolitan Government-Seoul National University Boramae Medical Center
Age/Sex 60 / M
Chief ComplaintAbnormality on plain radiograph. Hypertension and DM on medication

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Diagnosis With Brief Discussion

Diagnosis: Rhabdomyosarcoma
Radiologic Findings: Chest CT demonstrates a lobulating necrotic mass in the anterior mediastinum. The mass abuts on the right anterior chest wall and right upper lobe. FDG PET-CT shows hypermetablic lesion (SUVmax 9.4) in the anterior mediastinum.
Brief Review: Rhabdomyosarcomas are rare thoracic neoplasms that occur within the lung, bronchi, mediastinum, heart, and chest wall. They have a wide age range of presentation but typically occur in childhood or in the fifth to seventh decades of life with a male predominance. It can originate from any part of the thorax and the presence of striated muscle tissue is not a prerequisite for its development. However, it most frequently originates from the chest wall or diaphragm in the adult age group. The prognosis is determined by the extent and degree of differentiation of the tumor; well-differentiated tumors have the best prognosis, and survival may be greater than 80% if the disease is localized. Since these tumors can remain clinically silent, they may have already reached large dimensions by the time of diagnosis. This is especially true for those masses originating from the chest wall. At radiologic analysis, rhabdomyosarcomas manifest as masses that are often large and of variable attenuation due to necrosis and cystic components within the masses. The tumors can extend into or invade the neighboring vessels and bronchi.
References: 1) Gladish GW, Sabloff BM, Munden RF, Truong MT, Erasmus JJ, Chasen MH. Primary thoracic sarcomas. Radiographics 2002; 22:621-637.
2) M Almberger, E Iannicelli, M Matrunola, A Schiavetti, P Capocaccia. Integrated diagnostic imaging of thoracic rhabdomyosarcoma. Eur Radiol 2001; 11:506-508.
3) Araoz PA, Eklund HE, Welch TJ, Breen JF. CT and MR imaging of primary cardiac malignancies. RadioGraphics 1999; 19:1421-1434.
Keywords: Mediastinum, Malignant tumor,

No. of Applicants : 90

▶ Correct Answer : 2/90, 2.2%

- UWO , Canada S Lee
- Himeji St.Mary Hospital , Japan Yuichiro Kanie

▶ Correct Answer as Differential Diagnosis : 3/90, 3.3%

- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- All India Institute of medical sciences , India Justin Moses

▶ Semi-Correct Answer : 18/90, 20.0%

- Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
- University of British Columbia , Canada Amr Ajlan
- GHICL , France manuel toledano
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Kohka Public Hospital , Japan Akitoshi Inoue
- CNUH , Korea (South) Kim Soohyun
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Asan medical center , Korea (South) Sang Young Oh
- Asan Medical Center , Korea (South) Sang Min Lee
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- DongA University hospital , Korea (South) Jiyoung Kang
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Seoul university hospital , Korea (South) Youngjin Ryu
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
- China Medical University , Ditmanson Medical Foundation Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 796 Date 2013-01-28

Discussion

No. of Applicants : 90