Tumors of the Chest 1

8/16/2019 Tumors of the Chest 1

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Salient Features

• 18 years old• Female• Unmarried• G2P2 (2002)• Multiple upper chest mass•

Pallor and weakness• months onset o! illness• "um#ness o! the $roin area and #oth le$s• %yspnea• &ou$h• &onstipation• '#dominal pain• Upper a#dominal enlar$ement• 'nterior neck masses• Prolon$ed #leedin$• ei$ht loss• 'menorrhea


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UM*+S *F ,- &,-S

1. Pulmonary /a. eni$n#. Mali$nantc. Metastatic2. Mediastinal /

a. Primary#. hymusc. eratoidd. "euro$enice. ymph node!. ascular3lymphatic

$. Fattyh. hyroid and Parathyroid4. &ardiac and Pericardiac5. %iaphra$matic6. Chest wall


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UM*+S *F ,- &,-S'

• %i7erential %ia$nosis #y issue o! *ri$in /Soft tissueeni$n / heman$ioma lymphan$ioma

lymphangiomatosis 9#romatosislipoma

in!ectionMali$nant / rhabdomyosarcoma, lymphoma,

breast carcinoma metastases,choriocarcinoma, ovarian ca

Skeletal tissue

eni$n / osteochondroma enchondroma aneurysmal#one cyst osteoid osteoma histiocytosis :Mali$nant / chondrosarcoma ewin$s;P"-

osteosarcoma.


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%


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ymphan$iomatosis+ule in

?6@ in=ol=ed multi system or$an.

Present #y a$e o! 20

Pro$ressi=e in youn$er a$e

&ardiothoracic symptoms

chronic cou$h wheeAin$ dyspnea(shortness o! #reath)Bespecially serious

when occurrin$ at rest or when lyin$ downB!e=er chest pain rapid heart#eat diAAinessan:iety and cou$hin$ up #lood or chyle


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'#dominal /a#dominal !ullness anddistensionC anemia disseminatedintra=ascular coa$ulopathy (%


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ymphan$iomatosis+ule out

"ormal &-'

ecause it is rare and has a wide

spectrum o! clinical histolo$ical andima$in$ !eatures dia$nosin$lymphan$iomatosis can #echallen$in$


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ymphan$iomatosis

Review of Literature

• e!ore the a$e o! 20

• Multi system disorder /

•

3 &ardiothoracic / chroniccou$h wheeAin$dyspnea (shortness o!#reath)Bespeciallyserious when occurrin$ atrest or when lyin$ down

B!e=er chest pain rapidheart#eat diAAinessan:iety and cou$hin$ up#lood or chyle.

Salient features

• 18 years old !emale

• Multi system disorder /

3 !e=er cou$h dyspneadiAAiness.

3 &ou$hin$ o! #lood


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ymphan$iomatosis

Review of Literature• a#dominal pain and;or distensionC

nausea =omitin$ diarrheaC decreasedappetite and malnourishment.

• hen the disease a7ects the kidneysthe symptoms include Dank pain

a#dominal distension #lood in theurine and possi#ly ele=ated #loodpressure which may result in it #ein$con!used with other cystic renaldisease.

• hen lymphan$iomatosis occurs in theli=er and;or spleen it may #e con!usedwith polycystic li=er disease

• Symptoms may include a#dominal!ullness and distensionC anemiadisseminated intra=ascularcoa$ulopathy (%


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ymphan$iomatosis

Review of Literature• a#dominal pain and;or distensionC

nausea =omitin$ diarrheaC decreasedappetite and malnourishment.

• hen the disease a7ects the kidneysthe symptoms include Dank pain

a#dominal distension #lood in theurine and possi#ly ele=ated #loodpressure which may result in it #ein$con!used with other cystic renaldisease.

• hen lymphan$iomatosis occurs in theli=er and;or spleen it may #e con!usedwith polycystic li=er disease

• Symptoms may include a#dominal!ullness and distensionC anemiadisseminated intra=ascularcoa$ulopathy (%


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ymphan$iomatosis

Review of Literature

• Multiple osteo#lasticand osteolytic .

Salient features

• Multiple osteo#lasticand osteolytic

chan$es in=ol=in$ thethoracic =erte#rae andpel=ic #ones.


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reast &a metastasis

Review of literature

• '$e 40350

• *ccasionally #reast cancerpresents as metastatic

diseaseBthat is cancerthat has spread #eyond theori$inal or$an. hesymptoms caused #ymetastatic #reast cancer will

depend on the location o!metastasis. &ommon sites o!metastasis include #oneli=er lun$ and #rain.21

Salient features

• '$e 18 years old

• Symptoms o!

metastatic to li=erlun$ and #ones

http://en.wikipedia.org/wiki/Metastatichttp://en.wikipedia.org/wiki/Metastatic_breast_cancerhttp://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Metastatic_breast_cancerhttp://en.wikipedia.org/wiki/Metastatic


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reast &a


• Une:plained wei$ht losscan occasionally heraldan occult #reast canceras can symptoms o!!e=ers or chills. one or

Hoint pains cansometimes #emani!estations o!metastatic #reast canceras can Haundice orneurolo$ical symptoms.

Salient features


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reast &a


• ' lump or thickenin$ in the#reast chest wall or armpit

• ' chan$e in the siAe or shapeo! the #reast or a dimple orpucker in the skin o! the#reast.

• %ischar$e or #leedin$ !romthe nipple that occurswithout sIueeAin$ the

nipple.' chan$e in thenipple such as a scaly orcrusty look or a nipple thatdraws inward.

Salient features

http://www.webmd.com/pain-management/picture-of-the-armpithttp://www.webmd.com/pain-management/picture-of-the-armpit


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reast &'+ule in

&ommon sites o! metastasis include #oneli=er lun$ and #rain.

Une:plained wei$ht loss can occasionally

herald an occult #reast cancer as cansymptoms o! !e=ers or chills.

one or Hoint pains can sometimes #emani!estations o! metastatic #reast canceras can Haundice or neurolo$ical symptoms


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reast &a+ule out

'$e 50 360 years old

http://en.wikipedia.org/wiki/File:En_Breast_cancer_illustrations.gif


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,od$kin ymphoma

Salient features

• ymphadenopathy

• Systemic symptoms

• Pulmonary disease• one disease

• i=er disease

• +enal mani!estation

• ,ematolo$icmani!estation


• ymphadenopathy

• Mediastinal adenopathy

•

Splenome$aly• Systemic symptoms

• Pulmonary disease

• "eurolo$ic mani!estation

• one disease

• i=er disease

• +enal mani!estation

• ,ematolo$ic mani!estation


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ymphoma+ule in

ymphadenopathy

Mediastinal adenopathy

Systemic symptoms

Pulmonary disease

"eurolo$ic mani!estation

one disease

i=er disease+enal mani!estation

,ematolo$ic mani!estation


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•


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+ule out

Splenome$aly


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*=arian &a metastasis

Salient features

• Upper a#dominalenlar$ement

• Fe=er• '#dominal pain

• -asy satiety

• '#dominal !ullness

• =omitin$


• Most typicalsymptoms include

#loatin$ a#dominal orpel=ic pain ordiscom!ort diJcultyeatin$ indi$estionheart#urn nauseaearly satiety andpossi#ly urinarysymptoms.

http://en.wikipedia.org/wiki/Bloatinghttp://en.wikipedia.org/wiki/Satietyhttp://en.wikipedia.org/wiki/Satietyhttp://en.wikipedia.org/wiki/Bloating


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*=arian &a metastasis

Salient features

• '#dominal mass

• &hest masses


• ' mass pressin$ on theother a#dominopel=icor$ans or !rommetastases.11


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*=arian &a metastasis+ule in

Upper a#dominal enlar$ement

Fe=er

'#dominal pain-asy satiety

'#dominal !ullness

omitin$'#dominal masses


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+ule out

"ot ha=in$ children is a risk !actor!or o=arian cancer

increased a$e !amily history o!o=arian cancer

http://en.wikipedia.org/wiki/Nulliparityhttp://en.wikipedia.org/wiki/Nulliparity


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&horiocarcinoma

Salient features

• ,emoptysis

• &hest pain


• increasedIuantitati=e K3h&G

le=els• =a$inal #leedin$

• shortness o! #reath

• hemoptysis (cou$hin$

up #lood)• chest pain

http://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Vaginal_bleedinghttp://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Vaginal_bleedinghttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropin


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&horiocarcinoma

Salient features

• &hest : ray showsnodulo3haAy

in9ltratesC consider#ilateral pneumoniaC+;* metastaticdisease.


• chest L3ray shows multiplein9ltrates o! =ariousshapes in #oth lun$s

• wei$ht loss (!rom e:cess#eta h&G cross reactin$with the , FS, and S,receptor) in males

•

can present withincreasedthyroid3stimulatin$ hormone (S,)

http://en.wikipedia.org/wiki/Chest_X-rayhttp://en.wikipedia.org/wiki/Thyroid-stimulating_hormonehttp://en.wikipedia.org/wiki/Thyroid-stimulating_hormonehttp://en.wikipedia.org/wiki/Thyroid-stimulating_hormonehttp://en.wikipedia.org/wiki/Thyroid-stimulating_hormonehttp://en.wikipedia.org/wiki/Chest_X-ray


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+ule in

shortness o! #reath

hemoptysis (cou$hin$ up #lood)

chest painchest L3ray shows multiple in9ltrates

o! =arious shapes in #oth lun$s

http://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Shortness_of_breath


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+ule out

increased Iuantitati=e K3h&G le=els

=a$inal #leedin$

presents in males as a testicular neoplasm

sometimes with skin hyperpi$mentation (!rome:cess #eta h&G cross reactin$ with the alphaMS, receptor) $ynecomastia and wei$ht loss(!rom e:cess #eta h&G cross reactin$ with the

, FS, and S, receptor) in malescan present with increased thyroid3stimulatin$

hormone (S,)


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&olorectal carcinoma

Salient features

• &onstipation

• oss o! appetite

• "ausea• omitin$

• ei$ht loss

(3) #lood in stool

(3) decrease in stoolcali#er

(3) chan$e in #owel ha#it


worsenin$ constipation#lood in the stooldecrease in stool cali#er

(thickness) loss o!appetite loss o! wei$htand nausea or =omitin$ insomeone o=er 60 yearsold.11 wei$ht loss and

chan$e in #owel ha#it aretypically only concernin$i! associated with#leedin$


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+ule in

&onstipation

oss o! appetite

"auseaomitin$

ei$ht loss


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+ule out

#lood in stool

(3) decrease in stool cali#er

(3) chan$e in #owel ha#it


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%isseminated u#erculosis

Salient feature

• Fe=er

• ei$ht loss

• ymphadenopathy• 'nore:ia

• Multiple upper chestmass

• Pallor and weakness

• "um#ness o! the $roinarea and #oth le$s

Review of literarture

• Fe=er

• ei$ht loss

• ymphadenopathy• 'nore:ia

• Multiple upper chestmass

• Pallor and weakness

• "um#ness o! the $roinarea and #oth le$s


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%isseminated u#erculosis

Salient feature

• %yspnea

• &ou$h

• '#dominal pain• Upper a#dominal

enlar$ement

• 'nterior neck masses

• Prolon$ed #leedin$

Review of literarture

• %yspnea

• &ou$h• '#dominal pain

• Upper a#dominalenlar$ement

• 'nterior neck masses

• Prolon$ed #leedin$


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+ule in

%yspnea

&ou$h

'#dominal painUpper a#dominal enlar$ement

'nterior neck masses

Prolon$ed #leedin$


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ymphoma and%isseminated

%isseminated tu#erculosis may rarely presentwith a clinical picture similar to lymphomaN

% re!ers to in=ol=ement o! two or morenon3

conti$uous sites. %issemination canoccurdurin$ primary in!ection or a!terreacti=ationo! a latent !ocus;re3in!ection .% may mimicas lymphoma or mayoccur in patients o!

lymphomaNOushwaha et al &ase report %isseminated #

mimickin$ ymphoma


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Documents

Tumors of the Chest 1