INTRODUCTION: Spindle cell carcinoma is an aggressive and invasive tumor with significant morbidity and mortality 1. Our case is of a patient with stage 1V disease with invasion of svc, right atrium and pulmonary artery that underwent diagnosis via approach of the internal jugular vein.
CASE PRESENTATION: A case of a 54 year old Caucasian male living in shelter with past medical history of Hepatitis C, 20 pack year smoking, Intravenous drug use, recurrent bronchitis, presented to medicine clinic with chief complaint of cough and dyspnea. Patient was given a course of treatment of moxifloxacin for possible bronchitis, PPD was placed, Rapid HIV test (negative) and was to get a Chest roentgenogram. Patient was called immediately by the Clinic Physician after results of Chest X-ray, where patient was found to have >7 cm mass in the right hilum and right sided pleural effusion. Patient was asked to undergo CT chest with IV contrast for further evaluation of the mass, the results showed right hilar mass, with compression of right main stem bronchus possible pulmonary embolism and right atrial thrombus. Patient was admitted to our tertiary care hospital and was started immediately on Heparin for possible pulmonary embolism. Patient later underwent Chest tube placement for evaluation of Pleural effusion for cytology. Transthoracic Echocardiogram, Transesophageal Echocardiogram and was found to have soft tissue density extending from the SVC into the right atrium. Heparin was discontinued because of this findings and Cardiothoracic Surgery consult for possible surgical intervention. Patient remained afebrile while on antibiotics and had symptomatic improvement in dyspnea and cough after chest tube placement. After multidisciplinary discussion with Interventional radiology, cardiothoracic surgery and pulmonary teams’ discussion was made to biopsy via Right internal jugular approach. Pathology results showed Spindle Cell Sarcoma. These findings were discussed with patient by providing treatment options and prognosis, patient opted for Hospice care.
DISCUSSIONS: Lung neoplasm should be considered in patients with risk factors of smoking and symptoms of cough and dyspnea. Spindle cell Sarcoma is an aggressive tumor, with many case reports describing patients with invasion of the pericardium, great vessels and esophagus at initial presentation such as in with our patient2. There are many different methods for evaluation of lung mass including sputum cytology, thoracentesis, fiberoptic bronchoscopy, Ultrasound, EUS and CT guided biopsy, mediastinoscopy and thorocoscopy. All risk and morbidity should be individually evaluated with each patient before proceeding with any procedure. Bronchoscopy can reveal the degree of stenosis of the main-stem bronchus and is the method of choice for biopsy because it is minimally invasive. In this unique case we used Internal Jugular vein guided biopsy of the mass in the SVC to diagnose Spindle cell Carcinoma of the lung.
CONCLUSION: Many different methods are present for evaluation of lung neoplasm but non invasive strategy should always be considered. A rare case of Spindle cell Sarcoma was found on pathology results after undergoing biopsy of the mass found in the SVC.
DISCLOSURE: Anil Gogineni, No Financial Disclosure Information; No Product/Research Disclosure Information