Pulmonary artery intimal sarcoma is a rare highly lethal disease, with additional retrograde extension to pulmonic valve and right ventricle being an extremely rare condition. It is frequently mistaken for pulmonary thromboembolism. We report a case of 64-year-old woman with progressive dyspnea initially suspected and treated for pulmonary thromboembolism. Her helical chest CT scan with 3 dimensional (3D) reconstruction combined with echocardiography revealed a compacting main pulmonary artery mass extending to the right ventricular outflow tract and the right pulmonary artery. After excision of the mass, the patient's condition improved dramatically, and the pathologic findings revealed pulmonary intimal sarcoma. This report emphasizes that helical chest CT with 3D reconstruction can be an important tool to differentiate the characteristics of pulmonary artery lesions, such as intimal sarcoma and thromboembolism.
Diagnosis, Differential ; Echocardiography ; Female ; Human ; Imaging, Three-Dimensional ; Middle Aged ; Pulmonary Artery/pathology/*radiography ; Sarcoma/pathology/*radiography/ultrasonography ; Tomography, X-Ray Computed/*methods ; Tunica Intima/pathology/radiography ; Vascular Neoplasms/pathology/*radiography/ultrasonography

Undifferentiated sarcoma is an uncommon primary malignant tumor of the liver typically occurring in older children. It is also referred to as malignant mesenchymoma, fibromyxosarcoma, or mesenchymal sarcoma. We experienced a case of undifferentiated sarcoma in 72-year-old male. Contrast enhanced liver CT scan revealed a 3.4 cm heterogeneously enhancing, ill-defined, and low attenuated mass in the left liver and subtle intrahepatic duct dilatation. And, in tubogram, there were segmental stenosis and occlusion from the hilum to the proximal common bile duct. We did ultrasonography guided liver biopsy. The pathologic finding revealed infiltrative growth of atypical cells with rhabdoid features. Some atypical cells showed clear cytoplasm, but no organoid pattern was identified. The stroma around atypical cells was filled with eosinophilic hyaline material. These tumor cells were positive for vimentin only, and the tumor was consistent with undifferentiated sarcoma of the liver.
Aged ; Bile Ducts, Intrahepatic/pathology ; Diagnosis, Differential ; Dilatation, Pathologic ; Humans ; Klatskin's Tumor/diagnosis ; Liver Neoplasms/*diagnosis/pathology/ultrasonography ; Male ; Positron-Emission Tomography ; Sarcoma/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed ; Tuberculosis/drug therapy/radiography ; Vimentin/metabolism