2011 Volume 25 Issue 5 Pages 552-558
Background: Pulmonary sarcoma is a rare type of tumor. Radiotherapy and chemotherapy are usually not effective for its treatment, and surgical resection may be opted for. We surgically treated pulmonary sarcoma of the lung; the sarcoma protruded into the tracheal lumen and was accompanied by symptoms of suffocation.
Case: A 21-year-old man with transient suffocation symptoms induced by sputum was referred to our hospital. He was found to have a polypoid tumor arising from the right main bronchus, which extended centrally and almost entirely obstructed the lower trachea. The patient underwent an emergency rigid bronchoscopy-guided core-out procedure. The tumor, extending from the upper right lobe of the bronchus, was extirpated as much as possible. The core-out procedure resolved the right atelectasis and improved the patient's general condition. Since histological examination of the resected tissue suggested spindle cell sarcoma of the lung, right-sleeve pneumonectomy was performed after 40 days. The tumor originating from the upper right lobe had invaded the right tracheal wall. The trachea was resected from the 5th cartilaginous ring up to the bifurcation and then anastomosed with the left main bronchus. Anastomotic stricture occurred during the operation, and, thus, a Dumon stent was inserted at the anastomotic site. Although local recurrence was noted 4 months later, a favorable partial response was obtained by chemotherapy consisting of doxorubicin and ifosfamide. Chemotherapy became ineffective after the 11th course. The patient died 26 months after the operation.
Conclusions: Rigid bronchoscopy-guided core-out was successful in improving the general condition of the patient with primary sarcoma of the lung. It also provided information to make a diagnosis and determine the therapeutic strategy, thus allowing two-step tumor resection. The duration between the two-step surgery should be considered in the presence of rapid growth of the tumor. Dumon stent placement was useful for controlling the occurrence of anastomotic stricture during the operation.
