A rapidly developing lung mass diagnosed as desmoplastic small round cell tumor

Area of Science:

• Oncology
• Pulmonology
• Pathology

Background:

• A young male patient presented with symptoms suggestive of infection, including fever, cough, and sputum.
• The patient was already undergoing anti-tubercular therapy for a presumed diagnosis of tuberculosis.
• Initial investigations revealed right pleural effusion and liver abnormalities.

Purpose of the Study:

• To report a rare case of desmoplastic small-round-cell tumor presenting as a mediastinal and lung mass.
• To highlight the diagnostic challenges and aggressive nature of this rare tumor.

Main Methods:

• Clinical presentation and initial diagnostic workup including pleural fluid analysis and liver ultrasonography.
• Treatment with intravenous antibiotics and continuation of anti-tubercular therapy.
• Advanced imaging with computed tomography (CT)-guided biopsy for definitive diagnosis.

Main Results:

• Despite initial treatment, the patient's condition worsened, leading to mediastinal widening and a left lung mass.
• CT-guided biopsy confirmed the presence of a desmoplastic small-round-cell tumor.
• The tumor was identified as the cause of the patient's progressive symptoms.

Conclusions:

• Desmoplastic small-round-cell tumor is an extremely rare and aggressive malignancy.
• This case underscores the importance of considering rare diagnoses even in the presence of common symptoms like suspected tuberculosis.
• The tumor's presentation as a mediastinal and lung mass is uncommon and associated with a poor prognosis.