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  • FINE NEEDLE ASPIRATION CYTOLOGY OF INTRATHORACIC LIPOBLASTOMA A CASE REPORT

    Etty Hary Kusumastutia, Sjahjenny Mustokowenia, Dhihintia Jiwangga Sutab, Sutrisnoa

    Department of Anatomical Pathologya ; Department of Cardiovascular Thoracic Surgeryb, Medical Faculty Universitas Airlangga – Dr. Soetomo Academic General Hospital

    Surabaya, Indonesia

    INTRODUCTION  Lipoblastoma is a rare benign soft tissue tumor

     It most commonly found in first three years of life

     Predilection site : trunk and extremities

     Intrathoracic is uncommon site

    REFERENCE  Coffin C. M. Mandahl N. Lipoblastoma, in WHO classification of tumous of soft tissue and bone. 4th ed. IARC. 2013; 24-25.

     Han J., Kim H., Youn J. K., Oh C., Jung S., Park K., Lee S., Kim H. 2017. Analysis of clinical features of lipoblastoma in children.

    Pediatric hematology and oncology.

     Hudson A. S., Lacson A. G., Dicken B. J. Benign giant mediastinal lipoblastoma. Journal of pediatric surgery case reports. 40. 2019;

    38-42.

     Pradhan R, Mondal S, Pal S, Sikder M, Biswas B. Computed tomography-guided fine-needle aspiration and concurrent core biopsy

    in diagnosis of intrathoracic mass : An evaluation of 54 cases in a tertiary care hospital. Clinical Cancer Investigation Journal. 2018.

    7 : 176-9.

     Sekgololo J. M., Chauke R. F., Ramoroko P. S. Intrathoracic lipoblastoma presenting with severe respiratory distress. Journal of Pedi-

    atric Surgical Case Report 27 . 2017; 7-11.

     Ziegler A. C., Karplus G., Serour F., Peer M. Huge mediastinal lipoblastoma in a nine year-old boy successfully removed surgical.

    Heart, Lung and Circulation. 2015; 1-3

    CASE  10-year-old boy

     Cough in three months and getting more frequent

     Shortness of breath intermittently

     Respiratory rate 30x/minutes

     Asymmetric chest with suprasternal and subcostal

    retraction

     Decreased vesicular sound on the right lung

    CT scan showed a huge mass measured 12,5 x 11,5 cm on me-

    diastinum, with fat density majority, suspected as teratoma

    and thymolipoma

    FNAC guided by CT scan . Left : cytology composed of lipoblast which is small, round, uniform

    nuclei. Chromatin is delicate. Nucleoli are absent. Right : thin branching capillaries, lipid vacuole

    and sparse myxoid matrix background.

     Some pieces of tissue, total weight 500 grams

     Yellowish colour with gelatinous area.

    Tumour show lobulated appearance with admixture

    of mature and immature adipocyte, corresponding

    lipoblast.

    Chest X Ray revealed opacification of

    mass density on the right hemithorax

    with trachea shifts to the left.

    DISCUSSION  Lipoblastoma is benign tumor originated from em-

    bryonic white fat cells (Coffin et al, 2013).

     It constitute less than 1 % of childhood neoplasm. 90

    % cases present in first three years of life (Ziegler et

    al, 2015).

     Two-thirds are found in extremities (Hudson et al,

    2019).

     Rare location : retroperitoneum, thoracic wall, heart,

    lung, mediastinum (Hudson et al, 2019).

     The symptom depends on the site (Hudson et al,

    2019).

     CT scan is important in determining tumor margins,

    depth of tumor extension and even the origin

    (Sekgololo et al, 2017).

     FNAC is one of a diagnostic tools with high sensi-

    tivity (84,62%) and accuracy (85,18%) for intratho-

    racic lesion (Pradhan et al, 2018).

     FNAC is less invasive diagnostic tools

     Recurrence rate after complete resection has been re-

    ported approximately 25% (Han et al, 2017).

     Ki67 is associated with cell proliferation and predict

    tumour recurrency (Han et al, 2017).

    CONCLUSION  Intrathoracic lipoblastoma is a rare benign tumour.

    FNAC as pre-operative cytology procedure is useful

    to diagnose lipoblastoma, although a histopathology

    examination is needed for definitive diagnosis

    Ki67 expressed in less than 1 % of nuclear

    staining