Extraskeletal Ewing's sarcoma presenting as a mediastinal mass with vena cava superior syndrome: A rare case report.

INTRODUCTION: Extraskeletal Ewing's Sarcoma is a rare entity of sarcoma that develops rapidly within soft tissue in any anatomic region, and the symptoms depend on its location. CASE PRESENTATION: The X-ray examination of a 28-year-old man with shortness of breath, cough, weight loss, and chest pain showed malignant round cell, in which confirmed by immunohistochemical examination. The examination indicated positive Vimentin findings in the cytoplasm and positive FLI-1 in the nuclei of the tumour cells. The diagnosis was consistent with extraskeletal Ewing's sarcoma. The patient submitted to a chest conference and received radiotherapy related to SVCS before debulking surgery. DISCUSSION: The diagnostic challenges associated with Ewing's sarcoma may arise due to its diverse histological spectrum. Further examination is required in order to distinguish Ewing's sarcoma from other tumours, as its radiological specificity is limited. A multimodal approach for treatment and therapy is necessary to highlight the specific requirements of the patient's condition. CONCLUSION: Imaging modalities including X-rays and thoracic CT scans, supported by histopathological examination and immunohistochemistry, are essential for accurately diagnosing Extraskeletal Ewing's sarcoma. A multimodal approach may be considered as the best treatment for the patient with mediastinal Ewing's sarcoma.

Expression of MAGE A1 to MAGE A10 in the Forceps Biopsy and Bronchoalveolar Lavage Specimens from Patients with the Central Lung Tumor.

OBJECTIVE: The objective was to evaluate the expression of the MAGE A subtypes family in the central lung tumor patients from the forceps biopsy (FB) and bronchoalveolar lavage (BAL) specimens and to analyze its association with the histopathological examination. METHODS: An observational study was conducted on 32 FB and 43 BAL specimens from patients with central lung tumors. All samples were assessed for glyceraldehyde-3-phosphate dehydrogenase (GAPDH) expression by reverse transcription (RT) polymerase chain reaction (PCR) and samples showing a positive result were examined for MAGE A subtypes family expression by nested-RT PCR. RESULT: The MAGE A1 to MAGE A10 genes were highly expressed in the FB and BAL specimens from patients with central lung tumors. The MAGE A1 to MAGE A10 gene and MAGE A1 to MAGE A6 gene were expressed in 60/75 (80%) and 16/75 (21.3 %), respectively. MAGE A8, MAGE A9, and MAGE A10 were the most commonly expressed. In FB specimens diagnosed without malignant cells, MAGE A1 to MAGE A10 and MAGE A1 to MAGE A6 were positive in 16/18 (88.9 %) and 1/18 (5.6 %), respectively. In all BAL specimens were diagnosed with no malignant cells, but MAGE A1 to MAGE A10 and MAGE A1 to MAGE A6 showed positive results in 36/43 (83.7%) and 9/43 (20.9%) %), respectively. There was a significant association between MAGE A1 to MAGE A6 expression with histopathological diagnosis. CONCLUSION: The MAGE A subtype family genes are highly expressed in central lung tumor patients from FB and BAL specimens, even in specimens that were diagnosed with no malignant cells. All BAL specimens were diagnosed as no malignant cells, but expression of the MAGE A subfamily genes was found in more than 80% of the specimens. These observations suggest that combining histopathological and molecular examination could improve the diagnosis of lung malignancy.

The MAGE A1-A10 Expression associated with Histopathological Findings of Malignant or Non-Malignant Cells in Peripheral Lung Tumors.

OBJECTIVE: The objective was to evaluate the expression of melanoma antigen (MAGE) A from A1 to 10 (A1-10) and the individual MAGE A family in the peripheral lung tumors and to analyze its association with histopathological findings. METHODS: A cross-sectional study was conducted on 67 samples of peripheral lung tumor obtained by core biopsies from patients with clinical diagnoses such as lung and mediastinal tumors. The specimens were divided into two, one to perform histopathological diagnosis and the last for mRNA MAGE A examination. A Nested polymerase chain reaction (PCR) was performed using universal primer, MF10/MR10 and MF10/MR12. The collected data were analyzed by appropriate statistical techniques. RESULT: The histopathological finding showed 41 (61.2 %) of specimens as malignant cells and 26 (38.8 %) of specimens as non-malignant cells. MAGE A1-10 was expressed at 47 (70.1 %) and MAGE A1-6 was expressed at 25 (37.3 %) of specimens. In a malignant cell, MAGE A1-10 and MAGE A1-6 were expressed at 33 (80.5 %) and 19 (46.3 %), respectively. In non-malignant cells, MAGE A1-10 and MAGE A1-6 were expressed at 14 (53.9 %) and 6 (23.1 %,) respectively. The MAGE A1-10 and MAGE A8 expressions were significantly associated with histopathological findings of malignant or non-malignant cells. The sensitivity, specificity, and diagnostic accuracy of MAGE A1-10 were 80.5 %, 46.2 %, and 67.2 %, respectively; while for MAGE A8 were 41.5 %, 88.5 %, and 59.7 %, respectively. CONCLUSION: The MAGE A1-10 expression was the most commonly detected and associated with the histopathological finding. Moreover, it was more sensitive and specific and had higher diagnostic accuracy than others. Therefore, the MAGE A1-10 assay may improve the accuracy of the diagnosis of malignancy in peripheral lung tumors.

Interleukin-6 (IL-6) expression of lung tissue in COVID-19 patient severity through core biopsy post mortem.

Introduction: In COVID-19 patients, Interleukin-6 (IL-6) will increase, and the production of antigens will be excessive, which will cause excessive inflammation of the tissues, especially the respiratory tract, which causes fibrosis in the lungs and can lead to death. Objective: To analyze IL-6 expression of lung tissue in COVID-19 patient severity. Methods: The study is an observational analytic design from July to December 2020. COVID-19 patient severity who died was examined for IL-6 expression on lung tissue. The lung tissue sampling uses the core biopsy method. Results: The total number of samples obtained was 38 samples. Characteristics of patients with a mean age of patients were 48 years, male, the most common chief complaint was shortness of breath, mean symptom onset was 5 days, patient length of stay was 10 days, the most common cause of death was a combination of septic shock and ARDS and the most common comorbid diabetes mellitus. There is an increased WBC, neutrophils, platelets, procalcitonin, CRP, BUN, creatinine serum, AST, ALT, and D-dimer. In this study, the average tissue IL-6 expression was 72.63, with the highest frequency of strong positive 47.4%. Conclusion: An increase in IL-6 expression on lung tissue showed the severity of COVID-19 infection.

Deadly dust: Silicotuberculosis as a downplayed and overlooked fatal disease in Indonesia.

Background: Silicosis is one of the most common diseases among all occupational diseases. The main clinical focus on the silicosis complication will be tuberculosis. Case presentation: A 28-year-old male presented with complaints of chronic dry cough, weight loss, decreased appetite, and night sweats. The patient worked in the synthetic leather factory for 7 years and rarely used proper protective equipment. Chest X-ray showed bilateral fibroinfiltrate as a sign of a specific process in the lungs. Thoracic HRCT suggested an infected cystic type of bronchiectasis. Bronchoalveolar lavage from bronchoscopy was performed. The result of the silica spectrophotometric test and GenXpert BAL was both positive for silicosis and tuberculosis, consecutively. The patient has been diagnosed with an occupational lung disease accompanied by tuberculosis complications, namely silicotuberculosis. The patient received tuberculosis therapy and was advised to an early retirement due to disability. Discussion: The duration and level of intensity of exposure, as well as the severity of silicosis, are factors of tuberculosis. The silicosis diagnosis can be made from occupational history or silica exposure, as well as appropriate radiological and histopathological findings. Conclusion: Silicotuberculosis is a disease due to silica exposure, and is often found in TB endemic countries.

Conformity of Fine Needle Aspiration Biopsy (FNAB) and Core Needle Biopsy (CNB) in peripheral lung tumor patients: A cross-sectional study.

Background: The problem of establishing lung tumor diagnostics is a challenge for clinicians, especially pulmonologists, in determining a definitive diagnosis of a lung tumor. Objective: Analyzing the conformity of anatomical pathology results between fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) materials in peripheral lung tumors. Methods: A cross-sectional study was conducted from July 2019 to December 2020 with 66 participants. Participants were examined for CNB and FNAB, in which the results of these examinations were compared for conformity. Statistical analysis used the Kappa test with p < 0.05. Result: Most participants' tumor size was >70 mm, with FNAB results showing malignant category (39.5%), non-malignant (40.0%), and undiagnosed (38.9%; p = 0.757). Meanwhile, CNB examination showed a tumor size of >70 mm that was categorized into malignant (40.4%) and non-malignant (33.3%; p = 0.510). Most tumors were located in the right superior lobe that had FNAB results in the malignant (39.5%), non-malignant (30.0%) and undiagnosed (27.8%; p = 0.306) categories. The CNB examination also showed that most tumors were located in the right superior lobe, which had resulted in the category of malignant (34.4%), non-malignant (26.7%), and undiagnosed (75.0%; p = 0.240). Conformity of anatomical pathology results from FNAB and CNB subject such as malignancy category of 35 participants (74.5%), non-malignancy of 7 participants (53.8%) and undiagnosed of 4 participants (16.7%) with an accuracy of 69.69% (Κ = 0.43; p = 0.001). Conclusion: There is a conformity between the anatomical pathology results from FNAB and CNB materials for the diagnosis of lung tumors. CNB showed better results in the detection of anatomical malignancy and specimen adequacy.

A female with solitary fibrous tumor pleura mimicking pulmonary sclerosing pneumocytoma in low resource setting: A case report.

BACKGROUND: Solitary fibrous tumor of pleura (SFTP) is a rare condition. Clinical symptoms and non-specific radiological features in both tumors make preoperative diagnosis difficult to establish. CASE PRESENTATION: A Javanese 47-year-old female complained of chest pain and shortness of breath which an X-ray and CT-Scan of the thorax showed giant cell metastases in the lung. Signs and symptoms indicate pulmonary sclerosing pneumocytoma (PSP) and the patient underwent thoracic surgery which was first performed with angiographic embolization. Furthermore, an anatomical pathology analysis was performed with suspected SFTP, supported by the IHC test, which found CD34 (+), EMA (-), and S100 (-). Thoracic surgery followed by radiotherapy and chemotherapy is recommended in SFTP patients. DISCUSSION: The SFTP and PSP have non-specific clinical symptoms and radiological features. Anatomic pathology and IHC test are definitive diagnostic tools from SFTP and PSP. Establishing a preoperative diagnosis of SFTP and PSP is quite difficult. Surgical resection is the treatment of choice for both. CONCLUSION: The comparison of SFTP and PSP can be seen results of the anatomical pathology analysis and IHC test.

Increase of lung function usage bronchoscopy in COVID-19 patients: Three case series in Indonesian adult.

BACKGROUND: COVID-19 is a virus that is spread by aerosol which can cause worsening of hypoxia and bronchoscopy procedures in COVID-19 patients may be considered. METHOD: The design of this study is a case series reported using the Preferred Reporting of Case Series in Surgery (PROCESS) 2020 Guideline. Data collection was carried out in the period January-April 2021. All participants underwent X-ray examination and blood gas analysis as well as signs of infection before and after bronchoscopy. RESULT: Three intubated patients with COVID-19 were confirmed from PCR nasopharyngeal swab present with worsening on chest X-ray. All three patients had a normal bronchial wall with some inflammation and thick mucus resulting in lung atelectasis and massive inhomogeneous opacity on chest X-ray. Patients showed improvement on chest X-ray after bronchoscopy intervention. CONCLUSION: The bronchoscopy procedure can improve the lung function of COVID-19 patients and if it is carried out by medical personnel who pay attention to universal precautions, it will minimize the occurrence of transmission.