Primary undifferentiated sarcoma in the thorax: a rare diagnosis in young patients

(and do not invade) the adjacent structures. Those formations can compress the kidney cortex, expand the sinus and distort the calyceal system. In some cases, small, predominantly peripheral, hypodense collections can be seen, with attenuation values of 0–15 HU (3). There may be thickening of the renal fasciae and retroperitoneal collections crossing the midline at the level of the renal hilum. After the administration of iodine contrast, there is no enhancement of the collections or of the walls of the cystic formations (6). In MRI, the cysts exhibit a low signal on T1-weighted sequences—although the signal strength can be increased if there is bleeding (6) —and a more intense signal on T2-weighted sequences, without enhancement. In addition, RL can be diagnosed on MRI scans by identifying perirenal lymphatic collections with inversion of the corticomedullary signal intensity (1,4) , as depicted in Figure 1—B,C,D. To suggest a diagnosis of RL, as well as to devise a treatment strategy and to prevent complications, it is essential to understand the radiological aspects of the disease and to differentiate it from other conditions that mimic cystic kidney disease. Although the combination of RL and renal failure is rare, knowledge of that association is also important to prevent comorbid conditions that can evolve with this complication, such as obesity and high blood pressure. et al. Chronic renal insufficiency in a boy with cystic renal lymphangiectasia: morphological findings and long-term follow-up. A 30-year-old man was admitted to the thoracic surgery department of a tertiary hospital for investigation of a thoracic mass. Having previously received treatment for pneumonia, he presented with a two-week history of progressively increasing pain in the right hemithorax and right flank, between the anterior axillary line and midaxillary line. On clinical examination, there was an absence of breath sounds in the right hemithorax. Computed tomography (CT) of the chest showed an extensive , heterogeneous, mostly solid mass in right thoracic region (Figure 1), with areas of inner content of low attenuation (21–26 Hounsfield units) and foci of bleeding, without intervening calci-fications and without osteolysis of the rib. Laboratory tests produced results within the limits of normality. The patient underwent percutaneous biopsy, and the pathology examination revealed undifferentiated sarcoma (Figure 2). Sarcomas represent a heterogeneous group of tumors derived from mesenchymal cells (1–3). They account for 1% of all neo-plasms and occur mainly in the extremities (in 60% of cases), gas-trointestinal tract (in 25%), …

(and do not invade) the adjacent structures. Those formations can compress the kidney cortex, expand the sinus and distort the calyceal system. In some cases, small, predominantly peripheral, hypodense collections can be seen, with attenuation values of 0-15 HU (3) . There may be thickening of the renal fasciae and retroperitoneal collections crossing the midline at the level of the renal hilum. After the administration of iodine contrast, there is no enhancement of the collections or of the walls of the cystic formations (6) . In MRI, the cysts exhibit a low signal on T1weighted sequences-although the signal strength can be increased if there is bleeding (6) -and a more intense signal on T2weighted sequences, without enhancement. In addition, RL can be diagnosed on MRI scans by identifying perirenal lymphatic collections with inversion of the corticomedullary signal intensity (1,4) , as depicted in Figure 1-B,C,D.
To suggest a diagnosis of RL, as well as to devise a treatment strategy and to prevent complications, it is essential to understand the radiological aspects of the disease and to differentiate it from other conditions that mimic cystic kidney disease. Although the combination of RL and renal failure is rare, knowledge of that association is also important to prevent comorbid conditions that can evolve with this complication, such as obesity and high blood pressure.
Primary undifferentiated sarcoma in the thorax: a rare diagnosis in young patients

Dear Editor,
A 30-year-old man was admitted to the thoracic surgery department of a tertiary hospital for investigation of a thoracic mass. Having previously received treatment for pneumonia, he presented with a two-week history of progressively increasing pain in the right hemithorax and right flank, between the anterior axillary line and midaxillary line. On clinical examination, there was an absence of breath sounds in the right hemithorax.
Computed tomography (CT) of the chest showed an extensive, heterogeneous, mostly solid mass in right thoracic region ( Figure 1), with areas of inner content of low attenuation (21-26 Hounsfield units) and foci of bleeding, without intervening calcifications and without osteolysis of the rib. Laboratory tests produced results within the limits of normality. The patient underwent percutaneous biopsy, and the pathology examination revealed undifferentiated sarcoma ( Figure 2).
Sarcomas represent a heterogeneous group of tumors derived from mesenchymal cells (1)(2)(3) . They account for 1% of all neoplasms and occur mainly in the extremities (in 60% of cases), gastrointestinal tract (in 25%), retroperitoneal space (in 20%), and the head and neck region (in 4.1%). Primary sarcomas of the thorax are exceptionally rare, accounting for only 0.2% of lung cancers and only 5% of all the thoracic neoplasms. Such sarcomas can involve the lungs, mediastinum, pleura, and, mainly, the chest wall. The presence of sarcoma in any other part of the body must be ruled out, because metastasis to the chest is much more common than is primary sarcoma of the thorax (4)(5)(6)(7) .
The most common histological types of primary sarcomas are angiomyosarcoma, leiomyosarcoma, rhabdomyosarcoma, and sarcomatoid mesothelioma (8) . In the chest wall, the most common primary sarcomas are Ewing's sarcoma, primitive neuroectodermal tumor, malignant fibrous histiocytoma, chondrosarcoma, osteosarcoma, synovial sarcoma, and fibrosarcoma (8) . Radiologically, these tumors typically present as large, heterogeneous masses. However, their appearance can vary from an intrabronchial mass to an intravascular mass or even a solitary pulmonary nodule (8) .
In the case reported here, the patient was young, had no comorbidities, and presented with a voluminous mass in the right intrathoracic right region, the initial diagnostic suspicion pointing to sarcoma.
In accordance with the literature, the analysis of clinical data and CT images obtained can only suggest primary sarcoma of the thorax as one of the differential diagnoses; the differentiation between sarcoma subtypes is only possible through pathological examination of the biopsy sample (8) . Therefore, although it is a rare neoplasm, primary sarcoma must be considered among the diagnoses of thoracic tumors, especially when a large heterogeneous mass is identified in a young patient without evidence of malignancy in another part of the body.

Dear Editor,
A previously healthy 22-year-old female sought medical attention, complaining of productive cough and hoarseness. She reported no other respiratory or constitutional symptoms. Physical examination revealed discrete stridor. For diagnostic clarification, computed tomography (CT) of the chest was performed The CT scan showed grouped, branching centrilobular opacities, with the "tree-in-bud" aspect, suggesting distal bronchiolar filling. The trachea and left main bronchus presented irregular internal contours, with nodular thickening of the walls (Figure 1), together with a discrete increase in the density of the mediastinal fat adjacent to those changes. Sputum examination was conducted and was positive for tuberculosis, confirming the clinical and radiological suspicion of tracheobronchial tuberculosis. Specific treatment was started and resulted in resolution of the findings.
In patients with tuberculosis, tracheal involvement is relatively uncommon, occurring in only 4% of those with the endobronchial form of the disease (1)(2)(3) . Tracheobronchial tuberculosis mainly affects younger, female patients, its incidence peaking in the third decade of life. The disease can affect the greater part of the trachea, also affecting the bronchi, or it can affect just a small segment of the trachea or of one bronchus (4,5) . The clinical presentation can be insidious, simulating bronchogenic carcinoma, or acute, with a profile similar to that of asthma, foreign body aspiration, or pneumonia. In most cases, patients with tracheobronchial tuberculosis present a productive cough, hemoptysis, chest pain, generalized weakness, fever, dyspnea and bronchorrhea (1,3) . In cases that Tuberculosis: tracheal involvement are more severe, there can be acute tracheal obstruction (6) . The main complications are fibrotic scarring and tracheobronchial stenosis, an accurate diagnosis and early treatment being crucial (6) .