a young female , diagnosed as having koch's due to lesions in lungs mimmicking those of koch's,on akt, presented to us with a right breast lump [ 1 month history] of around 6x6cm size, nodulated with variegated consistancy , simple mastectomy done . H.P s/o malignant phylloides. now, should we consider the lesions in chest as metastasis of sarcoma. what should be the further line of Ix and Mx . should we go for BAL trans thoracic biopsy ?
It is important that the lesions in the lungs be biopsied since if these are metastases from the phylloides tumor, it is still possible to remove these surgically and eventually improve survival (if the lesions in the lungs are less than 16 in number). This can be done with percutaneous, CT guided biopsy. I'm not sure if BAL will yield a good result since sarcoma cells are very hard to diagnose from washings.
It is also important to prove that this is not a Koch's infection, since if you give chemotherapy to this patient and the lung lesions are Koch's, then the chemotherapy may cause a flare or spread of the Koch's infection and cause further clinical deterioration.
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