Spontaneous Pneumothoraces due to Metastatic Endometrial Stromal Sarcoma in a Woman Infected with HIV
Year: 2015
Type: article
Study design: Case Report
Abstract: A 41-year-old woman with HIV/AIDS (CD4 439 cells/mm 3 on antiretroviral therapy) presented with cough, dyspnea, and pleuritic chest pain.Chest imaging showed bilateral pneumothoraces as well as numerous solid and cystic subpleural pulmonary nodules and masses (Figure 1).Concurrent abdominopelvic imaging revealed uterine and bilateral adnexal enlargement.CA-125 was 41.5 U/ml (normal, ,20 U/ml).Pneumothoraces were managed with bilateral tube thoracostomy.Surgical lung biopsy yielded a diagnosis of metastatic endometrial stromal sarcoma (ESS) (Figure 2A).Two years earlier, a uterine mass had been diagnosed as leiomyoma by biopsy.In advanced HIV infection (CD4 ,200 cells/mm 3 ), pneumothoraces are typically associated with opportunistic infections.Our patient's reconstituted immunity, previous uterine pathology, and elevated CA-125 prompted consideration of alternative etiologies such as pulmonary metastases or thoracic endometriosis.Obtaining a definitive diagnosis of ESS is challenging.Common obstacles include inadequate sampling and confusion with other spindle cell entities due to overlapping cytopathologic profiles.In one retrospective series, 40% of uterine ESS cases were initially misdiagnosed as benign lesions, resulting in a mean diagnostic delay of 143 months (1).In our case, positive CD10 staining of lung biopsy tissue helped secure the diagnosis of metastatic ESS (2).Early detection is critical, because 5-year survival for stage III/IV disease is only 66% (3, 4).Our patient was initially managed with hysterectomy and megestrol acetate (5).Unfortunately, her disease progressed, and she was switched to exemestane, an aromatase inhibitor.n
Institution: Emory University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1888301292