Eadaches. She experienced no cough, hemoptysis, or shortness of breath but
Eadaches. She experienced no cough, hemoptysis, or shortness of breath but had recurrent episodes of upper respiratory tract infections in the past five months. There was no significant past medical history and she was a lifetime non smoker. Clinical examination revealed left lower lobe crackles. Routine blood tests revealed a White Cell Count of 11.82 109/lt and a C-Reactive protein (CRP) of 164 mg/lt. The chest radiograph (CxR) demonstrated a raised left hemi diaphragm with volume loss in the left lower lobe (Fig 1). Due to the equivocal findings on the CxR, she underwent a Computerized Tomography (CT) (Fig 2,) of her thorax which revealed a large necrotic mass within the left lower lobe extending into the posterior mediastinum, surround-Page 1 of(page number not for citation purposes)Journal of Cardiothoracic Surgery 2008, 3:http://www.cardiothoracicsurgery.org/content/3/1/ing PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26266977 the aorta and in close contact with the distal esophagus. It extended to the gastric fundus through extensive invasion of the left hemi-diaphragm. No mediastinal lymphadenopathy was reported. A CT guided biopsy was performed and the histology showed a spindle cell tumor. Immunohistochemistry revealed the tumor cells to be positive for CD 34, h-caldesmon (muscle marker) and focally positive for epithelial membrane antigen. The possibility of a ‘Oxaliplatin dose solitary fibrous tumor’ was raised as the clinical history indicated that this was primarily a chest tumor. She was subsequently referred to our team. At thoracotomy the tumor was invading the left lower lobe but large part of it was descending in the posterior mediastinum and through the hiatus. The initial incision was extended to a left thoracolaparotomy and the mass was resected en block performing a left lower lobe lobectomy, a distal esophagectomy, partial gastrectomy and diaphragmatic resection with primary esophagogastric anastomosis and diaphragmatic reconstruction. Figure 1 volume loss in the left lower lobe Chest radiograph showing a raised left hemi-diaphragm and Chest radiograph showing a raised left hemi-diaphragm and volume loss in the left lower lobe. On histopathological examination the tumor was predominantly composed of spindle shaped cells, with oval nuclei and eosiniphilic cytoplasm. Focal myxoid change was present. There was some nuclear pleomorphism and in areas the mitotic count was more than 5/50 high power field (HPF). Although the tumor was predominantly within the lung parenchyma, it was seen to be arising from the esophageal wall, where it extended into the lamina propria and attenuated the overlying esophageal squamous epithelium (figure 3).Figure depicting a well circumscribed tumor 9 cm craniothe posterior mediastinum caudally enveloping the descending aorta and extending into cm scan2 CT antero-posteriorly, 14 cm transversely and measuring 10 CT scan depicting a well circumscribed tumor measuring 10 cm antero-posteriorly, 14 cm transversely and 9 cm craniocaudally enveloping the descending aorta and extending into the posterior mediastinum.Figure 3 wall depicting H E stain of the Slide(Magnification power 5? GIST within the esophageal Slide depicting H E stain of the GIST within the esophageal wall (Magnification power 5?.Page 2 of(page number not for citation purposes)Journal of Cardiothoracic Surgery 2008, 3:http://www.cardiothoracicsurgery.org/content/3/1/Histologic features GISTs can exhibit either a spindle, epithelioid or mixed cytomorphology. Spindle cell GISTs are usually arran.