32 female non-smoker. Starburst shaped mass found in right upper lung (bit larger than a quarter) on x-ray and CAT scan. Treated as pneumonia and re-scanned one month later. Mass remained the same. Unable to reach mass via broncoscopy. PET scan showed areas of activity in lung, lymph nodes, liver, spleen, sternum and area below sternum. Lymph nodes not appreciated on physical exam. Ultrasound showed some inflammation in lymph nodes but not completely congruent with PET scan. Needle biopsy of lymph nodes benign. Thoracic surgeon scheduled her for thoracotomy next week. Any ideas? Fearing lymphoma and/or metastatic lung cancer because these were listed as "worrisome" on PET scan report. However, surgeon feels shape of mass is inconsistent with cancer. Any thoughts would be MOST appreciated.
A mass this size that was inaccessible by bronchoscopy is probably a peripheral mass. The starburst shape is worrisome for cancer but this could still be benign. The unresponsiveness to treatment for pneumonia provides no guidance as such a mass, if infectious, is more likely to be a fungal infection.
The PET scan can be positive for cancer, but not always. It can be positive for example, in sarcoid.
One can only speculate from imaging and a tissue diagnosis is absolutely necessary. If the mass is peripheral it could be accessible to needle biopsy or video assisted thoracoscopic surgery (VATS), thus avoiding a full thoracotomy, if it has not already been done. I would be most interested in what is found at surgery.
I knew a lady who had a large mass in her lung that was
NON-cancerous. She had surgery to remove it because it was affecting her breathing. Once she recovered from the surgery, she was back to her old self again.
Thank you to all who responded. Surgery was scheduled for this past Wed. The patient is my younger sister. She had her pre-op testing done last Thurs. When she met with her thoracic surgeon on Monday (2 days before thorocotomy surgery), he informed her the CAT scan showed the mass shrunk 4mm. It was originally 2.2 cm x 2.7 cm and is now 2.2 cm by 2.3 cm. So, they are now leaning towards this being "inflamatory." Great news, right? They left the decision up to her about whether or not to proceed with the thoracotomy but recommended waiting and re-scanning in a month. She chose to wait and did NOT have the surgery. However, they are still concerned about the lymph nodes in her medial-stinal (apologies, probably spelled wrong)and they also caution that it could still be cancer at the center of the lung mass with an inflamation (inflammation) around it that is shrinking. The previous biopsy of her lymph nodes was done on the nodes under her arm, not in her sternum area. She is now going to get another opinion from a different hospital. Fortunately, we live in Philadelphia and have many wonderful facilities to choose from. Any thoughts are appreciated and I will update the board as things progress.
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