Letter to the Editor
Primary pulmonary alveolar sarcoma. An unusual case
Sarcoma alveolar pulmonar primario. Un caso poco habitual
José Antonio Delgado Torralbo
, Estefanía Luque Crespo, María Pavón Masa
Corresponding author
Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, Spain
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An unusual case" "tieneTextoCompleto" => true "saludo" => "Dear Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "285" "paginaFinal" => "286" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Antonio Delgado Torralbo, Estefanía Luque Crespo, María Pavón Masa" "autores" => array:3 [ 0 => array:4 [ "nombre" => "José Antonio" "apellidos" => "Delgado Torralbo" "email" => array:1 [ 0 => "joseantoniodelgadotorralbo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Estefanía" "apellidos" => "Luque Crespo" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Pavón Masa" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoma alveolar pulmonar primario. Un caso poco habitual" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2376 "Ancho" => 2917 "Tamanyo" => 355248 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypercaptant image in the right lower lobe that makes contact with the diaphragmatic parietal pleura (arrow), obtained by Positron Emission Tomography.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Alveolar soft part sarcoma (ASPS) is a rare and aggressive entity, with a higher incidence in young adults. It typically arises in soft and deep tissue of the lower extremities.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Here presented is the case of a 62-year-old woman, non-smoker, with a personal history of mitral valve prolapse, with mild valve insufficiency, and histologically confirmed fibrocystic mastopathy. No treatment was being received on a regular basis. She came to the consultancy due to presenting self-limiting hemoptysis, with no accompanying dyspnoea, chest pain or palpitations, and weight loss of about 6 or 7 kg in the last year. Not associated with fever or night sweats. In the initial study, in the posteroanterior view of the thorax, an image of right supradiaphragmatic consolidation was observed. A computed tomography (CT scan) of the thorax was requested, which showed a «heterogeneous mass located in the anterior segment of the right lower lobe, which contacts with the diaphragm, with a diameter of 6 × 6.2 × 7.2 cm with well-defined contours and notable vascularisation. No mediastinal or hilar lymph nodes were noticed» (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the extensive CT examinations of the abdomen and pelvis, no alterations were noted. Given the finding, a fibrobronchoscopy was performed, in which a neoformative excrescent lesion was seen in basal subsegment 8. Multiple samples were extracted by biopsy and bronchial brushing. The histological result showed findings compatible with non-small cell carcinoma, but no further typing was possible with the immunohistochemical study. In the positron emission tomography (PET) scan, a pathological tracer uptake was detected, with a <span class="elsevierStyleItalic">maximum standardised uptake value</span> (SUVmax) of 7.8, in the region described previously (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). After finding normal values for spirometry, a lower right lobectomy with ipsilateral lymphadenectomy was performed. The biopsy of the surgical material was reported as alveolar sarcoma. Given this finding, it was agreed to perform a new PET scan, and include an evaluation of the lower extremities, to rule out a primary tumour in said location, with the findings being negative. The final diagnosis was primary alveolar soft part sarcoma of the lung pT2b N0 M0.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Alveolar soft part sarcoma is a malignant mesenchymal tumour with distinctive morphological, ultrastructural and cytogenetic characteristics.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It usually occurs in the extremities of adolescents and young adults (15–35 years), but it has also been documented in unusual locations, which often causes diagnostic confusion.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Tissues such as lung, liver or brain, when affected, are usually metastatic stations, presenting in the form of multiple and bilateral nodules.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Therefore, the primary lung involvement of this sarcoma, without evidence of soft tissue tumour elsewhere, is very exceptional.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Delgado Torralbo JÁ, Luque Crespo E, Pavón Masa M. Sarcoma alveolar pulmonar primario. Un caso poco habitual. Med Clin (Barc). 2020;154:285–286.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2376 "Ancho" => 2917 "Tamanyo" => 355248 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypercaptant image in the right lower lobe that makes contact with the diaphragmatic parietal pleura (arrow), obtained by Positron Emission Tomography.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastatic alveolar soft part sarcoma of the lung: metastatic alveolar soft partsarcoma of the lung-a morphologic pitfall on cytology and aberrant CD10 expression on histology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. 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