Revista Portuguesa de Pneumología ISSN: 0873-2159 [email protected] Sociedade Portuguesa de Pneumologia Portugal POSTERS EXPOSTOS Revista Portuguesa de Pneumología, vol. 23, núm. 3, noviembre, 2017 Sociedade Portuguesa de Pneumologia Lisboa, Portugal Disponível em: http://www.redalyc.org/articulo.oa?id=169753668003 Como citar este artigo Número completo Sistema de Informação Científica Mais artigos Rede de Revistas Científicas da América Latina, Caribe , Espanha e Portugal Home da revista no Redalyc Projeto acadêmico sem fins lucrativos desenvolvido no âmbito da iniciativa Acesso Aberto Document downloaded from http://www.elsevier.es, day 06/12/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. POSTERS EXPOSTOS PE 001 PE 002 A PLEASANT FINDING MALIGNANT CHEST PAIN A Pais, AI Coutinho, M Cardoso, A Pignatelli, C Bárbara A Pais, C Pereira, C Antunes, V Pereira, AI Coutinho, A Feliciano, Centro Hospitalar de Lisboa Norte C Quadros, A Ribeiro, L Carvalho, C Bárbara Centro Hospitalar de Lisboa Norte Key-words: mass, debridement, hamartoma Key-words: pain, S100, sarcoma 37-year-old male patient, salesman. Sporadic smoker. With a past history of allergic rhinitis and chronic gastritis. With no usual 26-year-old male patient, supermarket employee. Smoker of 10 medication. In January 2017, he was diagnosed with a respiratory pack-year. Past history of bronchial asthma in childhood. No rel - infection, having completed ten days of empirical antibiotic ther - evant family history. Without usual ambulatory medication. With apy with amoxicillin / clavulanic acid, with clinical improvement. a history of dry cough and chest pain in the posterior region of In May 2017, he underwent thoracic xray, which revealed homoge - the left hemithorax, for about two years, having had at that time, neous opacity of triangular morphology in the middle lobe of the chest X-ray without pathological findings, and the clinical picture right lung. He denied respiratory or systemic complaints, namely was interpreted as a muscular contracture. For nonspecific com - dyspnoea, cough, expectoration, hemoptysis, chest pain, fever, plaints of general malaise, weakness and weight loss of 5 kg in weakness or weight loss. He was referred to the Pneumology con - the last month, he consulted the general practitioner. For alter - sultation for etiological study. He did a CT scan, which revealed ations in the chest xray, he underwent thoracic CT, which showed collapse of the right lobe of the middle lung, with almost total a massive solid mass, about 14 cm longer, partially occupying occlusion of the corresponding bronchus, due to hypodense and the mediastinum, and partially the left lung, with loss of cleav - spherical intraluminal lesion. Bronchofibroscopy showed almost age planes with the aorta and the left pulmonary artery, asso - complete occlusion of the intermediate bronchus, by a polypoid ciated with homolateral pleural effusion and lytic destruction of mass. Subsequently, in rigid bronchoscopy, argon plasma therapy the posterior arch of an adjacent rib. The right lung had no alter - and mechanical debridement were performed, with reperfusion ations and there were no lymphadenopathy. He was hospitalized of the entire bronchial tree. The anatomopathological examina - for an etiological investigation. He underwent bronchofibroscopy tion was compatible with hamartoma. that revealed inflammatory signs and extrinsic compression of Hamartomas are the most common benign tumors of the lung. the left bronchial tree, but airway permeability was maintained. They are composed of tissues that are usually present in the Biopsies were performed at the lingula and at B1 / B2 levels, which respiratory tract (epithelial tissue, adipose tissue, smooth muscle, revealed mesenchymal neoplasia constituted by spindle cells with fibrous tissue and cartilage) but replicate in a disorganized way. S100 positivity, favoring the diagnosis of Malignant Tumor of the The vast majority (> 90%) are located in the periphery, with endo - Peripheral Nerve. He was referred to the Oncology Department, bronchial hamartomas being rare (~ 5%). They appear more fre - for staging and treatment, having started chemotherapy and con - quently between the fourth and fifth decade of life, and in the male comitant radiotherapy. sex (M: F = 2.5: 1). They are usually asymptomatic. Occasionally, The Malignant Peripheral Nerve Sheath Tumor, previously called they may cause symptoms of bronchial obstruction such as dys - Malignant Schwannomma, is a rare sarcoma (10% of sarcomas, pnoea, cough or hemoptysis. If symptomatic, surgical resection 1% of malignant neoplasms) and aggressive, originating from is recommended, with minimal recurrence rates. The prognosis is peripheral or cranial nerves. They may occur spontaneously, excellent with negligible malignant transformation risk. or in association with Neurofibromatosis type-1 (NF-1) or von The importance of these tumors is based on the differential diag - Recklinghaussen’s Disease, in about 50% of cases. It is most nosis of other, more aggressive tumors, especially carcinomas or common between the 3rd and 5th decade of life, and in patients carcinoid lung tumors. with previous radiation exposure. Often, it presents as a painful, fast-growing mass and may be associated with other neurolog - ical symptoms such as weakness or paresthesias. The diagno - sis is confirmed by the pathological and immunohistochemical examination (50 to 90% of the cases stain for the S100 protein). Staging is based on histological grade, tumor size and presence or absence of metastases. The treatments available are surgery, radiotherapy and chemotherapy. They are neoplasms with a very reserved prognosis, highly resis - tant to chemotherapy and with a high rate of recurrence, so it is so important to perform a rapid and effective diagnosis. Document downloaded from http://www.elsevier.es, day 06/12/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. POSTERS EXPOSTOS PE 003 PE 004 AN ORGAN NOT TO FORGET PULMONARY ADENOCARCINOMA: EGFR /ALK /ROS1 STATUS DID NOT CORRELATE WITH PD-L1 A Pais, W Videira, P Barradas, E Vitorino, A Pignatelli, C Bárbara Centro Hospitalar de Lisboa Norte L Carvalho 1-3 , A Alarcão 1-3 , AF Ladeirinha 1-3 , MR Silva 1-3 , L Teixeira 1, F Silva 4, JM Ruivo 4, P Teixeira 4, V Sousa 1-3 Key-words: swelling, anterior mediastinum, carcinoma, radiotherapy 1Institute of Anatomical and Molecular Pathology, Faculty of Medicine of the University of Coimbra, Coimbra; 2CIMAGO – Research Center for 39-year-old male, non-smoker. With diagnosis of multinodu - Environment, Genetics and Oncobiology, Faculty of Medicine, University 3 lar goiter with hypothyroidism, since the eighteen years of age. of Coimbra, Coimbra; Centre of Pulmonology, Faculty of Medicine of the University of Coimbra; 4Anatomical Pathology, University Hospital Coimbra Medicated with levothyroxine. No other relevant personal or fam - ily history. Referred by the General Practitioner, to the Emergency Key-words: PD-L1, EGFR , ALK , ROS1 Department of the Santa Maria 's Hospital, because of “new” heart murmur, and swelling in the left hemithorax. He reported fatigue for minor exertion and weight loss of 5 kg in the last six Introduction: Anti PD/PD-L1 immunotherapy dependent from months. He also reported dry cough, of nocturnal predominance. PD-L1 immunohistochemistry raises controversy due to low He denied fever. He denied dyspnea, dysphagia, or dysphonia. At accuracy of PD-L1 scoring/immunohistochemistry staining. This the physical examination, he was without fever, hemodynamically biomarker runs together with EGFR /ROS1 /ALK status for target stable, eupnoeic and with peripheral oxygen saturation of 99%. therapy. He presented with left parasternal non painful swelling of stony Objective: A series of 55 cases of pulmonary adenocarcinomas consistency, as well as with, digital clubbing and a holosystolic with Molecular Pathology determinations after clinicians demand - cardiac murmur grade III / VI. The chest xray showed left para - ing had PD-L1 (22C3 DAKO) immunostainning. sternal mass of well delineated contours. Transthoracic echocar - Methods: PD-L1 immunoexpression was correlated with EGFR diography revealed circumferential pericardial effusion with no (exons 19 and 21) and ALK and ROS1 status through Bond Max ® or functional significance, and severe pulmonary hypertension (esti - Ventana Ultra ®. EGFR mutations were search by Sanger sequenc - mated PAP of 65 + 8 mmHg). He was hospitalized for further ing and ALK /ROS1 status were assessed by FISH (ZytoLight SPEC investigation. A thoracic CT scan revealed a large heterogeneous ALK/EML4 Tricheck and ZytoLight SPEC ROS1 Dual Color Break mass in the anterior mediastinum, with a larger diameter of about Apart Probe FISH assay, respectively). 9 cm, which invaded the thoracic wall, right ventricle, trunk of Results: From the PD-L1 positive cases (<5% - 19), one case (5% the pulmonary artery, and with associated pericardial effusion positive cells) had EGFR L858R mutation. All cases were ALK and and bilateral pleural effusion. He underwent thoracoscopy with ROS1 negative. From the 36 negative PD-L1 cases, 5 presented a biopsy that revealed slightly differentiated, non-keratinizing EGFR E746_A750 or L858R mutations. carcinoma. In an additional immunohistochemical study, GLUT1 Conclusion: This work showed that there might not be