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A4091 - Pulmonary Artery Sarcoma Diagnosed by Endovascular Catheter-Guided Biopsy: A Case Report
Author Block: H. Tsubata1, N. Nakanishi1, K. Yanishi1, K. Zen1, T. Yamano1, T. Nakamura1, H. Shiraishi1, T. Shirayama1, S. Matoba1, S. Numata2, H. Yaku2, H. Tsuneduka3, M. Inoue3; 1Cardiology, Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan, 3Thoracic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Pulmonary artery sarcoma is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy. Early diagnosis and radical surgical resection are needed for the long term prognosis. However, preoperative histopathological diagnosis remains quite difficult owing to the location of the tumor. We report a case of 44-year-old man who was diagnosed as pulmonary artery sarcoma by the specimen from endovascular catheter-guided biopsy. He was suffered from dyspnea on effort and referred to our hospital as chronic thromboembolic pulmonary hypertension. Enhanced computed tomography revealed complete obstruction of right pulmonary artery. Positron emission tomography with 2-deoxy-2-fluoro-D-glucose with computed tomography demonstrated the abnormal uptake in the right pulmonary artery. Any tumor markers were not elevated in the blood examination, and there were no findings suggesting metastasis except for right lung, suspecting the pulmonary malignant tumors such as pulmonary artery sarcoma. For the treatment of right pulmonary artery tumor, accurate preoperative pathological diagnosis was desired. Firstly, endovascular aspiration biopsy has been attempted to diagnose pulmonary artery tumor, but we cannot get enough tissue sample due to its hardness. Therefore, we performed endovascular biopsy using catheter-guided biopsy forceps. In comparison with endovascular aspiration biopsy, catheter-guided forceps biopsy could obtain larger core tissues, and we could get the preoperative definite diagnosis of pulmonary artery sarcoma. He was treated by resection of the tumor and reconstruction of the main pulmonary artery with the heart arrested, and right pneumonectomy with the heart beating under cardiopulmonary bypass. We confirmed the diagnosis with pulmonary artery sarcoma from surgical specimen as same as endovascular catheter-guided forceps biopsy. Although pulmonary artery sarcoma has poor prognosis, we could confirm preoperative definite pathological diagnosis and undergo radical surgery. Four months after surgery, no recurrence has been observed. Our cases suggest that catheter-guided forceps biopsy is a feasible approach to the tissue diagnostic option for pulmonary artery sarcoma.