Objetivo: Determinar a contribuição da biópsia percutânea com agulha cortante (Trucut) no diagnóstico das massas mediastínicas. Método: Revisão retrospectiva de 56 doentes com massas mediastínicas submetidos a biópsias com agulha cortante orientadas, mas não guiadas, pela tomografia computadorizada do tórax, no período de 1999 a 2008. Resultados: A biopsia percutânea com agulha cortante forneceu material adequado para o diagnóstico em 49/56 casos, com índice de positividade de 88%. Em 7/56, o material colhido foi insuficiente para definir o diagnóstico (12%). Este método foi capaz de definir o diagnóstico em 88% dos doentes: 23/56 (41%) linfomas; 12/56 (21%) timomas; 5/56 (3%) carcinomas tímicos; 3/56 (2%) carcinoma indiferenciado de pequenas células e 1/56 (0,6%) adenocarcinoma metastático, carcinoma epidermóide metastático, carcinoma neuroendócrino primitivo, plasmocitoma, teratoma, bócio. Após a biópsia, os doen tes foram submetidos a radiografia do tórax. Não houve nenhum tipo de complicação nestes doentes. Conclusão: A biópsia transtorácica com agulha cortante (Trucut) orientada, mas não guiada pela tomografia computadorizada, tem alto rendimento, esclrrecendo o diagnóstico na maioria dos portadores de massas mediastínicas e pode ser útil, evitando a toracotomia exploradora, nos casos de tumores do mediastino inoperáveis ou de tratamento quimioterápico.

Aim: To determine the contribution of percutaneous biopsy with core cutting needle (Trucut) in the diagnosis of mediastinal tumours. Method: Retrospective review of 56 patients with mediastinal lesions who underwent percutaneous core cutting needle biopsy, oriented but not guided by computer assisted tomography of the thorax, 1999 - 2008. Results: Percutaneous biopsy with core cutting needle provided adequate material in 49/56, with a total positive sample rate of 88%. In 7/56 (12%) cases the material was insufficient to define the diagnosis. Percutaneous core cutting needle biopsy established a specific histological diagnosis in 88% of the patients: 23/56 (41%) lymphomas; 12/56 (21%) thymomas; 5/56 (3%) thymic carcinomas; 3/56 (2%) small cell carcinoma and 1/56 (0.6%) metastatic adenocarcinoma, metastatic squamous cell carcinoma, neuroendocrine primitive carcinoma, plasmocytoma, teratoma and goiter. All patients underwent thoracic X-ray after the procedure. No complications were found in these patients. Conclusion: Percutaneous core cutting needle biopsy (Trucut) oriented but not guided by computer assisted tomography of the thorax is an easy and safe procedure which can provide a precise diagnosis in the majority of mediastinal tumours and can prevent the need for exploratory thoracic surgery in cases which are medically treatable or non-resectable.

O blastoma pulmonar é um tumor primário do pulmão, raro, de mau prognóstico e que acomete doentes mais jovens do que os portadores do carcinoma de células não pequenas do pulmão. Geralmente, são vistos sob a forma de grandes massas pulmonares, sintomáticas e com metástases para linfonodos mediastinais. Do ponto de vista anátomo-patológico, estes tumores são bifásicos, englobando na sua estrutura componentes mesenquimal e epitelial. Embora infrequente, este tipo de tumor deve fazer parte do diagnóstico diferencial das neoplasias pulmonares. Os autores apresentam um caso de blastoma pulmonar e fazem revisão da literatura.

Pulmonary blastoma is a rare primary lung tumor with poor prognosis that commonly presents at a younger age than the non-small cell lung cancer. Classicaly they are large, symptomatic tumors with lymph nodal metastasis and carry poor prognosis. Pathological examination revealed features suggesting a biphasic tumor with mesenchymal and epithelial components. Over 200 cases have been reported so far worldwide since the first description of the tumor in 1945. Authors present a case of pulmary blastoma with literature revision.

OBJECTIVE: To determine the contribution of percutaneous biopsy with core cutting needle in the diagnosis of mediastinal tumors. METHOD: Retrospective review of 22 patients with mediastinal lesions who were submitted to percutaneous core cutting needle biopsy, oriented, but not guided by computer assisted tomography of the thorax, between 1999 and 2002. RESULTS: Percutaneous biopsy with core cutting needle provided adequate material in 18/22 cases, with a total positive sample rate of 82%. In 4/22 cases, the material was insufficient to define the diagnosis (18%). Percutaneous core cutting needle biopsy established a specific histologic diagnosis in 82% of the patients: 8/22 (36%) lymphoma; 5/22 (28%) thymoma; 2/22 (11%) thymic carcinoma; 1/22 (6%) metastatic adenocarcinoma; 1/22 (6%) neuroectodermic primitive tumor; and 1/22 (6%) plasmocytoma. All the patients were submitted to a thoracic X-ray after the biopsy. No complications were found in these patients. CONCLUSION: Percutaneous core cutting needle biopsy oriented, but not guided by computer assisted tomography of the thorax, is an easy and safe procedure which can provide a precise diagnosis in most mediastinal tumors, and can prevent the exploratory thoracic surgery in inoperable or chemotherapy-treated cases.