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CASE REPORT   

Journal of Radiological Review 2020 November-December;7(6):506-12

DOI: 10.23736/S2723-9284.20.00056-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English, Italian

Diagnosis of a PEComa of the lung by computed tomography-guided percutaneous biopsy using an augmented reality navigation system

Gennaro CASTIELLO 1 , Eliodoro FAIELLA 1, Carlo ALTOMARE 1, Giuseppina PACELLA 1, Flavio ANDRESCIANI 1, Silvia VALLESE 2, Carla RABITTI 2, Bruno BEOMONTE ZOBEL 1, Rosario F. GRASSO 1

1 Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy; 2 Department of Pathology, Campus Bio-Medico University, Rome, Italy


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PEComa of the lung, also known as clear cell tumor or “sugar tumor”, is an extremely rare entity with only approximately 60 reported cases in the literature. It often shows a benign behavior and a differential diagnosis with other types of lung lesions, both primary and secondary, is fundamental due to its non-specific imaging features. We present the case of a 71-year-old man with a round mass in the middle lobe of the right lung which was discovered through a chest radiogram. The patient underwent a computed tomography-guided core-needle biopsy of the mass which permitted the diagnosis of a PEComa of the lung, based on histological and immunohistochemical analysis. The use of an augmented reality navigation system to perform the biopsy allowed to obtain an optimal specimen with a low risk of complications; an infrared based needle tracking system limited the needle repositioning maneuvers, therefore reducing traumatism on the chest tissues, procedural time and radiation exposition. Due to its usual hypervascularity, the diagnosis of this kind of tumors is generally made analyzing the postoperative specimen after surgical resection, which represents the main therapeutic strategy. Only in a few cases the diagnosis of PEComa of the lung was obtained preoperatively by core-needle biopsy. In our case, for the patient’s comorbidities, a correct preoperative diagnosis was necessary to drive an appropriate clinical management.


KEY WORDS: Perivascular epithelioid cell neoplasms; Lung; Biopsy, needle; Multidetector computed tomography; Pathology

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