3. History
• Presented with anterior chest wall swelling of 05 month duration which
was steady in growth but since two weeks it started to grow rapidly.
• He has chest pain since 03 month which is dull aching on the middle of
the sternum.
• He has Hx of easy fatigability but no Hx of SOB
• He has significant but unquantified weight loss and loss of appetite.
• Otherwise has no other positive pertinent history.
4. Physical Examination
• GA – CSL but comfortable
• V/S – Unremarkable
• Chest- There is 6×5cm tender, firm mass
which is attached to underlying sternum
just on the middle extending to lower
border and has healing surgical wound in
the lower border.
5. Work Up
Labs
All done on 27/07/14 E.C
• CBC
• WBC 11100/dl with Neut=74.1% and Hg=11.2 g/dl
• LFT
• ALT =2×
• ALP=3.2×
• RFT
• Crt=0.71mg/dl
6. Imaging
• Chest X-ray:- Unremarkable (Radiologist conclusion) done on 27/07/14E.C
• Abdominal U/S- Normal Study but commented on Chest wall mass as There is 5.4×4.5
cm anterior chest wall collection with destruction of the sternum.
• Chest CT- Showed sternal destructive lobulated homogeneous enhancing soft tissue
density mass measuring 6.5X6.4X5.3cm with compression of the Rt. Ventricle with
maintained fat plane.
• Conclusion:- sternal mass sec to ???
• DDX:- Lymphoma, Metastatic.
7. FNAC
Biopsy
• G/A:- Multiple gray brown nodular surfaced
fibro fatty tissue.
• Section show diffuse sheets of monotonous
population of dark blue round cells with
eccentrically places nuclei eosinophilic
cytoplasm along with binucleated &
multinucleated large cells & scattered
immature plasmablasts having large nuclei &
prominent nucleoli inflitrating in to underlying
adipose tissue.
• Conclusion:- chest wall suggestive of plasma
cell neoplasm.
Pathology
• Moderate cellular yeild contains
discohesive cells with abundant basophilic
cytoplasm perinuclear Hof, round
eccentric nuclei and clock face chromatin
along with binucleated, multinucleated
cells and frequent mitotic figure in
hemorrhage background.
• Conclusion:- Sternal mass sec.to
suspicious of plasmacytoma
14. History
• Presented with anterior neck swelling of 2 year duration which was pea sized
Initially but since 03 months it started rapid growth to attain current size.
• Associated with she has Hx of Rt upper anterior chest wall mass of 03 month
duration, which is rapid in growth and painful, which is constant and dull aching
in nature.
• She has been on PTU and propranolol Tx which initiated at local health facility
since 2 years for the Dx of Multinodular thyrotoxicosis.
• Associated with she has Hx of SOB, easy fatigability, LOA and unquantified but
significant weight loss.
15. Physical Examination
• G/A:- Comfortable
• V/S:- all are with in normal range.
• HEENT:
• There is isolated anterior neck mass on the left side of midline which move with
swallowing and protrusion of the tongue.
• It is round firm and smooth, measuring 4×3cm, and discreet and mobile.
• LGS: NSLAP. breast Exam is Unremarkable.
• Chest:- There is ill defined rt side upper anterior chest wall mass which
extends under the Rt clavicle on the mid clavicular line. Firm and tender.
16. • TSH:- <0.2mIu/L
• Ref:-0.35-4.5mIu/L
• CBC:
• LFT:
• Serum electrolyte.
• All within normal range
Work Up
17. Imagining
• Chest X-Ray:- Mass Large Upper lung zone mass like opacity with distraction
of anterior second rib. There are variable sized pulmonary nodule.
• Concl:- Mass like opacity in right upper lung zone (likely chest wall orgin) + Multiple
pulmonary Nodule.
• CT Scan:-Bilateral multiple pulmonary nodules seen. Rt side lytic rib lesion
seen with associated soft tissue mass. Intervening lung tissue has normal
attenuation. Imaged part of neck has enhancing nodule on the left lobe of
thyroid, has central calcification.
• Multiple pulmonary Nodules likely metastatic + r/o thyroid ca
19. Pathology
• FNAC: From thyroid show
• Low cellular yeild composed of sheets of clusters of bland follicular epithelial cells along
with thin colloid.
• Conclusion:- NCG
• FNAC:- From the chest wall show.
• Sheets and clusters of pleomorphic round to oval cells having fine chromatin prominent
nucleoli in metachromatic stromal nuclei.
• Conclusion:- Suggestive of round cell sarcoma.
