Contrast-Enhanced Dynamic Magnetic Resonance Imaging of Primary Pulmonary Leiomyosarcoma

Abstract

An abnormal opacity was found incidentally on chest radiography in a 19-year-old Japanese man with lumbago. Chest computed tomography (CT) revealed a 55 × 40 mm welldefined mass with smooth margins in the lower lobe of the right lung (S6). Contrastenhanced dynamic CT showed that the lesion was not enhanced, suggesting a cystic lesion, such as a bronchogenic cyst. However, contrast-enhanced dynamic magnetic resonance imaging (MRI) revealed enhancement of the lesion, which had a clear margin and homogenous consistency, suggesting a benign pulmonary solid tumor. Video-assisted thoracoscopic surgery, S6 segmentectomy, was performed, disclosing the lesion to be solid. Histopathologically, the tumor consists of spindle cells with ample eosinophilic cytoplasm arranged in an interlacing pattern. Immunohistochemical staining revealed positive desmin reactivity but was negative for α smooth muscle actin and HHF-35 (muscle specific actin), indicating atypical phenotypic differentiation. The lesion was accordingly diagnosed as leiomyosarcoma with low grade malignancy, and right lower lobectomy was performed. The patient has remained free from recurrence for 18 months without any additional chemotherapy or radiation therapy. Contrast-enhanced dynamic MRI should be carried out to facilitate accurate preoperative diagnosis and selection of the correct surgical plan.pulmonary; leiomyosarcoma; contrast-enhanced dynamic CT; cyst; contrast-enhanced dynamic MRI

Primary sarcomas of the lung: report of five cases and review of the literature

“…Our patient had a 4 cm lesion at the left lower lobe with suspicious diaphragma invasion. [26] The earliest case was reported in 1907 by Davidsohn [24,27]. Agnos and Starkey recorded 18 cases in 1958, Dyson and Tretalance reported 26 cases in 1964 [28] and Guccion et al and Nascimento et al have reported 41 cases [1].…”

Added value of DCE‐MRI in the management of cystic‐cavitary lung lesions

“…Although morphological assessments of cystic-cavitary lung lesions have been reported in previous studies with CT and MRI, only a few case reports have investigated the dynamic features of lesions. 5,19 DCE-MRI studies of the chest have primarily focused on solid lesions [14][15][16][17][18][19] and, no previous study has investigated the role of DCE-MRI in cysticcavitary lung lesions. Our results in cystic-cavitary lesions were concordant with the previous reports performed in solid lung lesions.…”

“…Computed tomography (CT) plays a primary role in diagnosis and serves as the standard of reference in the management of these lesions . Dynamic contrast enhanced magnetic resonance imaging (DCE‐MRI) has been reported to be useful in the differentiation of benign and malignant solid pulmonary lesions, providing discriminative dynamic features in addition to morphological ones . Malignant nodules are expected to show a stronger initial increase in contrast enhancement, a higher maximum peak (MP) and a faster slope, as well as a washout pattern on DCE‐MRI .…”

“…1,2 Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has been reported to be useful in the differentiation of benign and malignant solid pulmonary lesions, providing discriminative dynamic features in addition to morphological ones. [3][4][5] Malignant nodules are expected to show a stronger initial increase in contrast enhancement, a higher maximum peak (MP) and a faster slope, as well as a washout pattern on DCE-MRI. 6,7 Although several studies have compared solid nodules and masses using MRI, to the best of our knowledge, no previous study has investigated DCE-MRI characteristics in cystic-cavitary lung lesions.…”

Metastatic leiomyosarcoma of the intrapancreatic bile duct

“…Low-grade lesions and all lesions smaller than 5 cm are generally considered "cured" if adequately resected [4]. By contrast, the median survival for patients with unresectable sarcoma or metastatic disease is about 12 months [5].…”