Cale-Subia, Laarnie N.

De Luna, Arlene M.

Sagun, Leonisa S.

Elsevier - Publisher Connector 

Journal of Thoracic Oncology • Volume 2, Number 8, Supplement 4, August 2007  12th World Conference on Lung Cancer
Copyright © 2007 by the International Association for the Study of Lung CancerS800
ratio of 2.40 (95% CI 1.44, 3.99, p=0.001), 2.03 (95% CI 1.26, 3.26, 
p=0.003) and 1.83 (95% CI 1.01, 3.30, p=0.044), respectively. Median 
OS for nuclear-survivin positive (score 1-2) and negative (score 0) pa-
tients were 23 months (95% CI 15, 31) and 36 months (95% CI 1, 76), 
respectively (p=0.01); 5-yr survival for score 1-2 and score 0 patients 
were 20% and 44.5%, respectively. Conversely, no signiﬁcant impact 
on survival is found for patients stratiﬁed according to cytoplasmic 
survivin expression.
Conclusions: Data presented herein open the issue that prognosis of 
early stage of NSCLC can be linked to the cellular pattern of distribu-
tion of survivin. 
P1-162 Pathology Posters, Mon, Sept 3 
Cardiac leiomyoma: primary or benign metastasizing?
Cale-Subia, Laarnie N.; Sagun, Leonisa S.; De Luna, Arlene M. 
Philippine Heart Center, Quezon City, Philippines
Background: Cardiac neoplasms are a rare occurrence in clinical prac-
tice. Here, we present a case of a benign cardiac tumor with a history of 
previous uterine leiomyoma.
Objective: To describe a case of a rare benign cardiac tumor consid-
ered as benign metastasizing leiomyoma against primary cardiac tumor 
and underscore the usefulness of immunohistochemistry at arriving at 
the deﬁnitive diagnosis. 
Case Methodology: A 45-year old female was managed as a case 
of renal disease and found out to have a right atrial mass with signs 
of tamponade. Imaging diagnostics revealed a mass within the right 
atrium and inferior vena cava with a consideration of myxoma. Exci-
sion showed right atrial mass with inferior vena cava extension, the 
stalk is attached to the posterior of IVC. A benign spindle cell tumor 
favoring atypical leiomyoma was considered after a positive smooth 
muscle actin and negative S-100. Further immunohistochemistry of the 
patient’s uterine leiomyoma, showed positive estrogen receptor (ER), 
progesterone receptor (PR) and negative p53 while the cardiac mass 
showed negative reaction to ER, PR, and p53. The patient was weaned 
from cardiopulmonary bypass without difﬁculty. 
Results And Discussion: The patient is in her reproductive years, the 
usual presentation of primary cardiac neoplasms and benign metasta-
sizing leiomyoma. Benign metastasizing leiomyoma are usually found 
in the lungs with unclear pathogenesis after hysterectomy for uterine 
leiomyoma. Benign primary cardiac tumours are rare entities. The 
majority are myxomas (70%) with the rest as non-myxomatous. The 
patient presented with congestion because of large intracavitary mass 
occluding the right atrium that then causes hemodynamic insufﬁciency. 
Excision resolved the signs and symptoms. Tissue examination showed 
benign spindle cell tumor with hypercellular areas showing focal 
moderate atypia and lacking areas of tumor cell necrosis, hemorrhage 
with nil mitotic activity. A positive SMA and negative S-100 favors 
the diagnosis of atypical leiomyoma since primary cardiac leiomyoma 
is not reported in literature. Benign metastasizing leiomyoma is also 
entertained with history of uterine leiomyoma. This presents 10% 
cardiac involvement and may be misdiagnosed as a primary cardiac 
tumor. With negative ER, PR and p53, the cardiac tumor is conﬁrmed 
as primary cardiac leiomyoma. 
Conclusion: Benign cardiac neoplasms are extremely rare, with few 
being reported in literature. This is a case of 45-year old female with 
congestive heart failure and tamponade who incidentally found out to 
have a solid intracavitary mass on the right atrium. Tissue examination 
showed atypical leiomyoma after positive SMA. With history of uterine 
leiomyoma, benign metastasizing leiomyoma was entertained. Further 
immunostaining showed uterine leiomyoma with positive ER-PR and 
negative p53 against the cardiac tumor with negative ER-PR and p53 
thus conﬁrming the diagnosis of primary cardiac leiomyoma. 
P1-163 Pathology Posters, Mon, Sept 3 
Immunocytochemical evaluation of large cell neuroendocrine 
carcinoma of the lung for the more accurate preoperative diagnosis
Endo, Chiaki; Honda, Masako; Hoshi, Fumihiko; Sakurada, Akira; 
Miyamoto, Akira; Noda, Masafumi; Ishida, Itaru; Kondo, Takashi 
Department of Thoracic Surgery, IDAC, Tohoku Univ., Sendai, Japan
Background: It has been very difﬁcult to preoperatively distinguish 
large cell neuroendocrine carcinoma of the lung (LCNEC) not only 
from small cell lung cancer (SCLC) but also from non-small cell lung 
cancer (NSCLC) except LCNEC because only a small tissue specimen 
for histological examination can be obtained preoperatively. Enough 
quantity of cytological specimens can be obtained by bronchoscop or 
percutaneous ﬁne needle aspiration, so that cytological evaluation may 
be much useful and helpful to the preoperative diagnosis.
Methods: Tumor touch imprint cytological specimens of surgically 
resected NSCLC from Jan 2002 to Jan 2007 were studied. All the 
cases were histologically diagnosed as NSCLC. Immunocytochemistry 
was done by using the following primary antibodies; chrmogranin A, 
synaptophysin, neural cell adhesion molecule, neuron speciﬁc enolase, 
cytokeratin34βE12, cytokeratin18, E-cadherin and thyroid transcription 
factor-1.
Results: Histological diagnoses of twenty-six cases examined were as 
follows; LCNEC in two cases, adenocarcinoma in ﬁfteen cases, squa-
mous cell carcinoma in eight, and adenosquamous carcinoma in one. 
All LCNEC showed positive staining of chromograin A and negative 
staining of cytokeratin34βE12. All NSCLC except LCNEC showed 
negative staining of chromogranin A, and 88% of them showed positive 
staining of cytokeratin34βE12.
Conclusion: The current study revealed immunocytochemistry help us 
distinguish LCNEC accurately from other NSCLC, and indicated posi-
tive staining of chromogranin A and negative of 34βE12 is important 
to diagnose LCNEC cytologically. Final results of a total of a hundred 
cases will be presented. 
P1-164 Pathology Posters, Mon, Sept 3 
Vascular malformation in the posterior mediastinum: Report of a 
rare case
Gadingan, Donaldson M. 
Pathology Residents Organization, Quezon City, Philippines
Background: Arteriovenous malformations (AVM) are the most 
important type of vascular malformation and these can cause signiﬁcant 
morbidity and even mortality especially if deep soft tissue structures 
are involved. Their unorthodox locations and different clinical presen-
tations create concern to the part of clinicians, radiologists, patholo-
gists, and surgeons. As of today, only two cases of AVM in the posterior 
mediastinum have been reported and published.
Objective: To report a rare case of arteriovenous malformation (AVM) 
in the posterior mediastinum and present data and review of literature 
on rare posterior mediastinal tumors.


P1-162: Cardiac leiomyoma: primary or benign metastasizing? 

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P1-162: Cardiac leiomyoma: primary or benign metastasizing?

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