Green Gate, Bd. Tudor Vladimirescu nr. We present a case of a solitary pulmonary nodule discovered in a patient with resected rectal carcinoma, irradiated and chemotreated controlled disease.
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The initial management was CT follow-up; because the nodule dimensions increased, the surgical resection was performed: wedge pulmonary resection and lymphadenectomy. The pathological diagnosis was stage IA lung adenocarcinoma.
A newly appeared solitary pulmonary nodule in a patient with a history of malignancy could be a metastasis, however could also be a second primary cancer - lung cancer. Wedge pulmonary resection and lymphadenectomy is testicular cancer relapse symptoms appropriate surgical management for stage IA lung cancer in selected patients; this approach impose close follow-up for early detection of a local relapse.
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Diagnosticul anatomopatologic a fost de adenocarcinom pulmonar stadiul IA. Solitary pulmonary nodules are usually asymptomatic and most frequently conceal lung cancer 2.
Cancer risk increases with age, male gender and a smoking history. The nonneoplastic benign nodules are most commonly due to granulomas from prior infections and in our country, in a significant number of patients, they are caused by Mycobacterium tuberculosis 4.
Solitary pulmonary nodules in patients with a history of malignancy other than testicular cancer relapse symptoms cancer have a higher chance of being metastatic. Still, due diligence of a solitary pulmonary nodule is to treat it as an indeterminate nodule, with the possibility of being lung cancer, metastasis or a benign lesion 2,5.
CT scan follow-up of the pulmonary nodule at 6 months revealed growth from 1. Figure 1.
Native CT scan image of a left solitary pulmonary nodule presented case Figure 2. Contrast-enhanced CT scan image of the same solitary pulmonary nodule as in figure 1; the well-deligneated contour and the geographic area of endemic tuberculosis are benign criteria Results Following completion of clinical and paraclinical investigations and maintenance of her arterial hypertension we proceeded to surgery, performing a nonanatomic resection of the left superior lobe.
The intraoperative frozen section histopathology showed carcinomatous infiltration without being able to distinguish a histological origin. The final paraffin embedded histological sections and immunohistochemical tests confirmed lung cancer: a poorly differentiated G3 adenocarcinoma, without lymph node metastasis, pathological stage IA, pT1bN0M0.
The postoperative recovery was uneventfull, facilitated following a nonanatomical resection. The patient was forwarded towards the oncology ward. The therapeutical decision was follow-up. Discussion Figure 3. Spiculated aspect of the nodule; this aspect and the upper lobe localization, the history of malignancy, age over 35 years, dimension over 2 cm and growth in time testicular cancer relapse symptoms the malignant characteristics of the solitary pulmonary nodule 6 The prevalence of solitary pulmonary nodules in the general population is unknown.
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Higher rates are found in the elderly population, among smokers, in patients with nonthoracic neoplasms and in patients who are at risk for mycobacterial or fungal infections 2,6.
In Romania, there is no protocol for screening solitary pulmonary nodules or lung cancer. Owing to its superior resolution, high-resolution CT is a sensitive technique for identifying pulmonary testicular cancer relapse symptoms 4.
The American College of Chest Physicians developed an evidence-based clinical guideline to help establish the probability of malignancy of a pulmonary nodule 1.
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Predictors of malignancy include: older age, current or past smoking, history of extrathoracic cancer in the last 5 years, nodule diameter, spiculation and upper lobe location 2,5. PET-CT is a noninvasive functional imaging modality used for diagnosis, staging and evaluation of treatment response of lung cancer.
PET-CT is not indicated for nodules that are under 0. For lesions that are located in the center of the lung, we can use bronchoscopy with fluoroscopic guidance 9. For nodules situated in the outer third of the lung, transthoracic needle biopsy can help obtain a diagnosis. With a higher number of biopsy samples taken and a good on-site cytopathologyst, one may obtain a higher rate of positive results However, the imaging characteristics figures 1, 2, 3 classified it as an indeterminate nodule, and therefore compelled us to also consider lung cancer as a possibility.
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Our thoracic surgery clinic in National Institute of Oncology proposed in a protocol for solitary nodule based on the existence of a CT scan available, 1. American College of Testicular cancer relapse symptoms Physicians.
Evaluation of patients with pulmonary nodules: when is it lung testicular cancer relapse symptoms Solitary Pulmonary Nodule.