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      Leiomyosarcoma of the pulmonary artery diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

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          Abstract

          Leiomyosarcoma of the pulmonary vasculature is an extremely rare condition that has not been previously diagnosed by endobronchial ultrasound (EBUS) bronchoscopy. We present the case of a 43-year-old white male with a history of leiomyosarcoma who was diagnosed with pulmonary embolism 2 years ago. As the filling defects on follow-up chest computed tomography continued to worsen despite anticoagulation, EBUS-guided transbronchial needle aspiration (EBUS-TBNA) of the right pulmonary artery lesion was safely and successfully performed. Cytopathological examination revealed the “thrombus” to be metastatic leiomyosarcoma. In experienced hands, and carefully selected cases, EBUS-TBNA seems to be a safe and effective in diagnosing thoracic endovascular lesions.

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          Most cited references25

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          EBUS-TBNA in the differential diagnosis of pulmonary artery sarcoma and thromboembolism.

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            The expanding horizons of endobronchial ultrasound: diagnosis of a tumor embolism.

            A 51-year-old woman was given a diagnosis of primary retroperitoneal synovial sarcoma, which was surgically removed, and she was subsequently treated with chemotherapy and radiotherapy. Five years later, the patient was readmitted with a 1-month history of progressive dyspnea and was initially given a diagnosis of bilateral pulmonary embolism. Angiography performed some time later revealed progression of the previous filling defects and the appearance of two new nodular endovascular images. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed, and the cytologic analysis of the cell aspirate was compatible with endovascular metastatic sarcoma. In conclusion, EBUS-TBNA in the appropriate setting is an effective method for sampling endovascular lesions, adding pathologic information and allowing for early and accurate diagnosis.
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              Primary leiomyosarcoma of the pulmonary artery confirmed by catheter suction biopsy.

              A patient with clinical features consistent with pulmonary embolism showed no improvement despite therapy with tissue-plasminogen activator and full-dose heparin. Transvenous catheter suction biopsy was successful in establishing an antemortem histologic diagnosis of primary pulmonary artery leiomyosarcoma. Urgent surgical intervention was performed.
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                Author and article information

                Journal
                Endosc Ultrasound
                Endosc Ultrasound
                EUS
                Endoscopic Ultrasound
                Medknow Publications & Media Pvt Ltd (India )
                2303-9027
                2226-7190
                Oct-Dec 2014
                : 3
                : 4
                : 249-251
                Affiliations
                [1 ]Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, State University of New York, USA
                [2 ]Department of Medicine, Roswell Park Cancer Institute, New York, USA
                Author notes
                Address for correspondence Dr. Kassem Harris, E-mail: kassemharris@ 123456gmail.com
                Article
                EUS-3-249
                10.4103/2303-9027.144547
                4247534
                25485274
                112ce5c5-985b-47af-aa4d-6d55719b5d87
                Copyright: © Endoscopic Ultrasound

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 June 2014
                : 21 July 2014
                Categories
                Case Report

                biopsy,endobronchial ultrasound,leiomyosarcoma,pulmonary artery

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