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      Pleural Effusion with Mediastinal and Hemidiaphragm Mass Effect: A Case Report

      case-report
      Author(s): 1 , , 1 , 2
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: pulmonary effusion, leiomyosarcoma, metastases

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          Abstract

          Pulmonary metastases are a rare but aggressive and life-threatening complication of leiomyosarcoma. We discuss a case of a 48-year-old woman with stage 4b leiomyosarcoma who presented with dyspnea and hemodynamic instability secondary to a large lung metastasis with massive pleural effusion. This particular subset of patients is vulnerable to re-expansion pulmonary edema in a disease with poor survival rates.

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          Efficacy and safety of trabectedin in patients with advanced or metastatic liposarcoma or leiomyosarcoma after failure of prior anthracyclines and ifosfamide: results of a randomized phase II study of two different schedules.

          M Keohan, Scott Schuetze, K Hande … (2009)
          To evaluate the safety and efficacy of trabectedin in a phase II, open-label, multicenter, randomized study in adult patients with unresectable/metastatic liposarcoma or leiomyosarcoma after failure of prior conventional chemotherapy including anthracyclines and ifosfamide. Patients were randomly assigned to one of two trabectedin regimens (via central venous access): 1.5 mg/m(2) 24-hour intravenous infusion once every 3 weeks (q3 weeks 24-hour) versus 0.58 mg/m(2) 3-hour IV infusion every week for 3 weeks of a 4-week cycle (qwk 3-hour). Time to progression (TTP) was the primary efficacy end point, based on confirmed independent review of images. Two hundred seventy patients were randomly assigned; 136 (q3 weeks 24-hour) versus 134 (qwk 3-hour). Median TTP was 3.7 months versus 2.3 months (hazard ratio [HR], 0.734; 95% CI, 0.554 to 0.974; P = .0302), favoring the q3 weeks 24-hour arm. Median progression-free survival was 3.3 months versus 2.3 months (HR, 0.755; 95% CI, 0.574 to 0.992; P = .0418). Median overall survival (n = 235 events) was 13.9 months versus 11.8 months (HR, 0.843; 95% CI, 0.653 to 1.090; P = .1920). Although somewhat more neutropenia, elevations in AST/ALT, emesis, and fatigue occurred in the q3 weeks 24-hour, this regimen was reasonably well tolerated. Febrile neutropenia was rare (0.8%). No cumulative toxicities were noted. Prior studies showed clinical benefit with trabectedin in patients with sarcomas after failure of standard chemotherapy. This trial documents superior disease control with the q3 weeks 24-hour trabectedin regimen in liposarcomas and leiomyosarcomas, although the qwk 3-hour regimen also demonstrated activity relative to historical comparisons. Trabectedin may now be considered an important new option to control advanced sarcomas in patients after failure of available standard-of-care therapies.
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            Soft tissue sarcomas of the extremities.

            Liam J. Morrison (2003)
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              Benign metastasizing leiomyoma: clinical, imaging, and pathologic correlation.

              M Gilkeson, Jeremy S. Abramson, R Eisenberg … (2001)
              We describe the clinical presentation and the radiographic and CT findings of benign metastasizing leiomyoma. Benign metastasizing leiomyoma is an asymptomatic disease characterized by well-defined, numerous, pulmonary lesions without a preponderant distribution.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 12 August 2019
                Publication date (Electronic, collection): August 2019
                Volume: 11
                Issue: 8
                Electronic Location Identifier: e5372
                Affiliations
                [1 ] Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
                [2 ] Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, USA
                Author notes
                Article
                DOI: 10.7759/cureus.5372
                PMC ID: 6784915
                SO-VID: a7613621-2ace-492a-8f18-095b316ac781
                Copyright © Copyright © 2019, Bridwell et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 5 August 2019
                Date accepted : 12 August 2019
                Categories
                Subject: Oncology
                Subject: Pulmonology
                Subject: Emergency Medicine

                Keywords: pulmonary effusion,leiomyosarcoma,metastases
                Data availability:
                Keywords: pulmonary effusion, leiomyosarcoma, metastases

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