Solitary Fibrous Tumor of the Great Omentum: A Case Report and Literature Review

Background: We report a case of a 23-year-old man with a solitary fibrous tumor of the great omentum who presented clinically as a case of dull abdominal pain. Case Presentation: Solitary fibrous tumor normally occurs in the visceral pleura. Extrathoracic solitary fibrous tumor is rare, especially those from the great omentum, with approximately 31 cases reported in the literature. Conclusion: After reviewing and summarizing the imaging findings of 31 cases of solitary fibrous tumor of the greater omentum, we considered that the characteristic findings can provide a reliable basis for preoperative diagnosis.

Different patterns of pneumothorax in patients with soft tissue tumors treated with pazopanib: A case series analysis

To investigate pneumothorax patterns in pazopanib treatment by focusing on the positional relationship between the visceral pleura and metastatic lung tumor, we examined 20 patients with advanced soft tissue tumors who developed lung metastases and underwent pazopanib treatment between 2012 and 2019. Pneumothorax was classified into two types based on the location of the metastatic lesion around the visceral pleural area before pazopanib treatment: subpleural type, within 5 mm from the pleura; and central type, >5 mm from the pleura. We investigated the rates of pneumothorax and the associated risk factors. Five patients experienced pneumothorax (three subpleural and two central types). Cavitation preceded pneumothorax in 83% of patients and led to connection of the cavitated cyst of the metastatic lesion to the chest cavity in the shorter term in patients with the subpleural type. Conversely, a more gradual increase in the cavity size and sudden cyst rupture were observed in the central type. The risk factors for pneumothorax were cavitation after initiating pazopanib and intervention before pazopanib, either ablation or surgery. The location of the metastatic lesions was not a risk factor for the occurrence of pneumothorax. In conclusion, pneumothorax is an adverse event associated with pazopanib treatment. Therefore, attention must be paid to predisposing factors such as the formation of cavitation after pazopanib initiation and previous interventions to the lungs. Moreover, because subpleural pneumothorax tends to occur earlier than the central type, a different time course can be anticipated based on the positional relationships of the metastatic lesions to the visceral pleura.

Lung Ultrasound to Detect Pneumothorax or Mainstem Intubation

Chapter 2 covers the use of lung ultrasound to detect pneumothorax and mainstem intubation. In healthy patients, a layer of visceral pleura will slide on the parietal pleura with every breath. This can be readily imaged with a handheld ultrasound probe at the point of care, and this information can be used for diagnosis of pneumothorax or mainstem intubation. Lung ultrasound can also help the clinician to visualize pleural effusions or pulmonary edema. When trying to diagnose pneumothorax by imaging, lung ultrasound is more accurate for ruling pneumothorax in (level B evidence) or out (level A evidence) than supine anterior chest radiograph.

Not a Huge but Two Tumors

A 73-year-old man presented to the thoracic surgery clinic with progressive difficulty breathing for about 3 months. He had a benign spindle cell tumor (about 3 centimeter in diameter) in right lung upper lobe, which had been resected by thoracotomy surgery 15 years earlier. The physical examination showed weakened right respiratory sounds. Computed tomography of the chest revealed a huge mass closed to the pulmonary vessels and bronchus, which measured more than 13 cm in greatest dimension (Panel A). Thoracotomy surgery was performed for the tumor resection again. Two separated tumors, instead of one huge tumor, originated from visceral pleura were found with well encapsulated (Panel B). And the histopathological analysis revealed solitary fibrous tumor. The immunohistochemical analysis was positive for Desmin-protein and CD34. Just followingup was initiated after surgery, and the patient was doing well after 3 months.

Bilateral pneumothorax after acupuncture treatment

A 31-year-old female physician was diagnosed with bilateral pneumothorax a day after her acupuncture treatment. Her body mass index was 16.9 and she did not have a prior history of respiratory disease or smoking. Acupuncture needles may easily reach the pleura around the end of the suprascapular angle of the levator scapulae muscle where the subcutaneous tissue is anatomically thin. In our patient, the thickness between the epidermis and the visceral pleura in this area was only 22 mm as confirmed by an ultrasound scan. Although she felt chest discomfort 30 min after the procedure, she assumed the symptom to be a reaction to the acupuncture. In light of our case, we advise practitioners to select appropriate acupuncture needles for patients based on the site of insertion and counsel them regarding the appearance of symptoms such as chest pain and dyspnoea immediately after the procedure.

Macroscopic and microscopic morphology of the trachea and lungs of giant anteater (Myrmecophaga tridactyla)

ABSTRACT: Giant anteater (Myrmecophaga tridactyla) is a wild mammal distributed in Central and South America; nowadays, it is classified as an endangered species. Research about the macroscopic and histomorphological aspects of its respiratory tract is scarce, and, sometimes, it limits the treatment provided to sick animals and impairs species preservation. Thus, the present study aims to describe the macroscopic and microscopic morphology of its lower respiratory tract, including trachea and lungs. To do so, 12 adult giant anteaters from “Centro de Triagem de Animais Silvestres de Goiânia” (CETAS-GO), Goiás State, Brazil, were used in the research after natural death or euthanasia. Three of these animals were used for macroscopic assessments; they were fixed in 10% buffered formalin and dissected. Trachea and lung tissue samples were collected from nine animals right after death and fixed in 10% buffered formalin for histomorphological analysis; they were processed, embedded in paraffin, and inked with hematoxylin-eosin (HE), periodic acid-Schiff (PAS), and Masson’s trichrome. The macroscopic analysis showed that the trachea in this species is proportionally short and presents from 19 to 27 tracheal cartilages. The right lung presents four lobes and the left one, two. The microscopic analysis evidenced respiratory epithelium of the ciliated cylindrical pseudostratified type, without evident goblet cells in the mucosa layer of the trachea and bronchi. The pulmonary visceral pleura is thick, similar to other large domestic mammals - complete septa extend from the pulmonary visceral pleura. In conclusion, the macroscopy and histomorphology of giant anteater’s lower respiratory tract, represented by trachea and lungs, are similar to that of other domestic and wild mammals. Pulmonary histomorphology is mainly similar to that of pigs and ruminants: it has thick visceral pleura that emits complete septa of conjunctive tissue, which enable lobular parenchymal architecture.