A 38-year-old woman was admitted to rural areas with no known morbid history.
The patient presented a clinical picture characterized by general deterioration, weight loss (adequately 10 kg in three months) and lower limb edema.
She was treated symptomatically on several occasions in the rural health center of her sector.
He had an episode of hypoglycemia (26 mg/dl) which was treated with infusion of 10% glucose solution.
The patient had normal blood glucose levels and was admitted to our hospital.
The chest X-ray showed a right pleural occupation and deviation of the mediastinal structures.
Chest computed tomography showed a right pleural tumor with heterogeneous density, occupying the right hemithorax with compressive effect, right pulmonary atelectasis and mediastinal shift.
Other laboratory and imaging tests did not highlight other significant findings.
During hospitalization, she had several symptomatic hypoglycemia characterized by somnolence, impaired visual acuity, muscle weakness, episodes of dementia, episodes of mental illness and mental illness.
These hypoglycemic episodes occurred on different days and at least 7 blood glucose measurements were recorded between 27 and 58 mg/dl, on the second day of hospitalization two hypoglycemic episodes were recorded.
It was treated in each episode with infusion of 10% glucose solution.
Due to the difficult metabolic control, it was treated and studied together with the endocrinology team.
Measurements of basal insulinemia, cortisol and prolactin (TSH) were within normal ranges.
1.
A CT guided puncture biopsy was performed, the pathological anatomy study concluded that the lesion was compatible with a SPFT.
After ruling out another cause of hypoglycemia and in the context of a PFPS, surgical treatment was decided.
Surgical procedure
With monobronchial intubation (double-lumen endotracheal tube) and left lateral decubitus.
He was approached by a wide variety of right side tumours, with encapsulated appearance occupying the entire pleural cavity and displacing the mediastinal structures without walls.
The patient was adhered to the parietal lobe, with a wide implantation base and unidentifiable.
Adhesions were released and the tumor was macroscopically resected completely.
Adequate expansion of the right lung was observed after tumor resection.
Two pleural tubes (28 Fr.) were installed and closed as usual.
Postoperative Ev
The patient was admitted in the postoperative period without incidents.
She had no new episodes of hypoglycemia.
Pleural tubes were removed on the seventh day and discharged on the tenth postoperative day.
The pathological study concluded: PFPS of 27 x 25 x 11.5 cm and weight of 3.450 grams, with histological characteristics of malignancy.
The PFPS showed extensive macroscopic and microscopic tumor necrosis, up to 2 mitosis in 10 fields of higher increase and the surgical margins were free of injury.
Immunohistochemistry was positive for Vimentin and CD34.
At 15 months of follow-up, the patient is currently under adequate metabolic control, with normal glucose levels and is asymptomatic from a respiratory standpoint, with no clinical or radiological evidence of tumor recurrence.
