Dini Rachma Erawati
Department Of Radiology, Faculty Of Medicine, Universitas Brawijaya/Dr. Saiful Anwar General Hospital, Malang, Indonesia.

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Case Report Mediastinal Teratoma Resembling Vascular Tumor with Rapid Growth Accompanied by Vena Cava Superior Syndrome and Bilateral Paramalignant Pleural Effusion Rini, Ni Made; Pratiwi, Suryanti Dwi; Bayuadi, Imam Suseno; Erawati, Dini Rachma; Yudhanto, Hendy Setyo
Malang Respiratory Journal Vol. 2 No. 01 (2020): Shape the Curves
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2020.002.01.6

Abstract

Background: Teratomas are tumors originate from germ cells, consist of well differentiated tissue from more than one of three layers of embryonic cells: ectoderm, mesoderm and endoderm. Teratomas are generally slow-growing and asymptomatic. Mediastinal teratoma is the most common extra-gonadal germ cell tumor. Superior vena cava syndrome and bilateral paramaligant pleural effusion are complications which can occur in mediastinal teratomas. Case: We report a 37-year-old woman presented with shortness of breath since 1 month before admission, chest pain, cough, weight loss,  swolen of face, neck, and right arm. Chest x-ray showed mediastinal tumor. However, no mediastinal tumor had been detected by chest x-ray to examine her heart disease 3 years earlier. Chest computed tomography scan showed anterosuperior mediastinal tumor surrounding great blood vessels and bilateral pleural effusion. Computed tomography guided transthoracic fine needle aspiration biopsy revealed  tumor containing mature squamous epithelial component. Patient underwent open biopsy by sternotomy and histological assessment confirmed the diagnosis as mediastinal teratoma with vascular lesions predominantly resembling vascular tumor.Conclusion: Establishing the diagnosis of mediastinal teratoma is challenging and it requires multi modality approaches.  Keywords: Mediastinal teratoma, vena cava superior syndrome, bilateral paramalignant pleural effusion.
Rare Case Giant Cystic Mediastinal Tumor (Mature Teratoma) in 57 years old Woman Akbar, Jimmy Akbar; Parsama, Ngakan Putu Putra; Erawati, Dini Rachma; Wardhana, Koernia Kusuma; Yudhanto, Hendi Setyo
Malang Respiratory Journal Vol. 2 No. 02 (2020)
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2020.002.02.6

Abstract

Background : Incidence of mediastinal teratoma 8,5 - 13,6% of all patients in mediastinal tumor. Teratomas are most common in young adults. Mediastinal teratoma is rarely present clinical manifestation. The clinical manifestation present along with increasing size of mass and also reported with chest pain, back pain, shortness of breath and febrile caused by chronic pneumonia. Rupture of a mediastinal teratoma can cause pleural effusion, empyema and cardiac tamponade. CT is first modality of choice for tumour diagnosis.  Mature teratoma is a type of benign tumor, most patients will recovery after complete resection.Case Report : We report one case at Dr. Saiful Anwar hospital, an elderly woman, 57 years old with mediastinal teratoma, whose formerly differential diagnosed with empyema. On the diagnostic test found no evidence of empyema but leads to loculated cloudy pleural effusion. Physical and supporting examination showed anterior mediastinal tumors. Based on the CT-Scan and thorax sonography concluded that is a cystic mass on anterior right hemithorax dextra. The patient performed thoracotomy and eksploration with the final diagnosis of giant cystic mediastinum tumour, with the histopathology is mature teratoma.  Conclusion: In this patient, the diagnosis of mediastinal cystic mature teratoma  with loculated pleural effusion proven through a multidisciplinary approach covering the pulmonology, thoracic and cardiovascular surgery, radiology and histopathology. Key words : Mediastinal tumour, Mature teratoma
Case Report: 43-years old-Male with Pulmonary Sequestration which Mimics Lung Tumor and Aspergillosis Rumaratu, Simon Petrus Hardiyanto; Setyawan, Ungky Agus; Wardhana, Koernia Kusuma; Erawati, Dini Rachma; Yudhanto, Hendy Setyo
Malang Respiratory Journal Vol. 4 No. 1 (2022): Vol. 4 No. 1
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2022.004.01.4

Abstract

Background: Pulmonary sequestration is a very rare congenital abnormality of the lung, which was responsible for 0.15-6.4% of all cases of congenital lung formation disorders. Pulmonary sequestration is often seen as recurrent pneumonia, accompanied by complaints of chest pain, shortness of breath and hemoptysis. Conventional angiography is the gold standard for diagnosing pulmonary sequestration and for demonstrating arterial supply and venous drainage. The optimal therapy for pulmonary sequestration is operative resection to avoid infection and damage to the lung parenchyma. Case Report: We reported a case of 43-years old-male with pulmonary sequestration, previously diagnosed with a lung tumor with massive left pleural effusion and pneumonia. A series of diagnostic tests found no malignant cells. During FNAB with CT scan guiding, we found an image of a fungus ball, thus, he was diagnosed with Aspergillosis. The patient was planned to undergo VATS. There were complications during the operation, thus, a lobectomy with an open thoracotomy was performed, and an arterial anomaly was found from the abdominal aorta. The operation was successful and the patient was able to carry on with his normal activities.Conclusion: Establishing a definite diagnosis of pulmonary sequestration is very difficult, and in this case, it was done through lobectomy with thoracotomy and through a multidisciplinary approach.
A Case Report : Bronchopleural Fistula Dextra with Pyopneumothorax Dextra as Complication of Lung Tuberculosis Wahyudy Prasetyo, Kevin; Jani, Jane R Sugiri; Dini, Rachma Erawati; Wardhana, Kurnia
Malang Respiratory Journal Vol. 5 No. 1 (2023): Volume 5 No 1, March 2023
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2023.005.01.2

Abstract

Background: Bronchopleural fistula is a rare case that might be caused by trauma, post lung resection surgery, and non traumatic cause such as lung Tuberculosis infection. Bronchopleural fistula is a serious complication of lung TB which almostly related to pleural cavity infection. This fistula condition may be accompanied with empyema that can cause secondary spontaneous pneumothorax. The diagnosis of fistula is established by combination of clinical symptoms regarding lung TB infection, radiology, laboratory, microbiology, dan histopathologi examinations. Management of bronchopleural fistula includes chest tube insertion to treat pyopneumothorax problem, fistula repair surgery, and underlying disease and its comorbid. Case: We report one case located at Dr. Saiful Anwar hospital, a 36 year old woman with symptoms of dyspneu and chronic cough with purulent sputum. Based on the clinical data, laboratory results, radiological imaging, sputum examination, and plerual fluid analysis and cytology, diagnosis of bronchopleural fistula together with pyopneumothorax as complication of lung TB was made. Management of this patient comprises of chest tube insertion, fistula repair surgery, antibiotic, and OAT. Conclusion: Bronchopleural fistula is a rare case found. Proper surgical management and treating underlying disease such as lung TB might improve clinical outcome and reduce mortality rate. Keywords: Bronchopleural fistula, Pyopneumothorax, Lung TB
Tuberculous Dactilitis in Young Male, a Rare Case Yusdianto, Adrian; Tantular, Rezki; R. Sugiri, Yani Jane; Rahayu Sartono, Teguh; Rachma Erawati, Dini; Setyo Yudhanto, Hendy
Malang Respiratory Journal Vol. 5 No. 2 (2023): September Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2023.005.02.02

Abstract

Introduction : Chylothorax is an uncommon medical condition caused by the accumulation of chylous fluid in the pleural space. Chylothorax has no predilection for sex or age. The prevalence after various cardiothoracic surgeries is 0.2% to 1%. Mortality and morbidity rates are around 10%. Respiratory distress may occur due to compression of the lung by the accumulated fluid. Management and approaches to treating the condition require multidisciplinary therapy, starting from non-pharmacological, pharmacological, to interventional management. Case Report : A 57-year-old Man patient was referred to the emergency room with chief complaint of shortness of breath. Reduced breathing sound on both lung fields. No previous history of cancer or thoracic surgery were found. X-ray examination had found bilateral pleural effusion. Thoracocentesis and pleural fluid analysis was performed with total of 6800 cc serosanguinous, whitish fluid was extracted from both of the lung. The patient was diagnosed with chylothorax. Lymphangiography and embolization was performed on the leak on left thoracic duct (T10) from right lymph node. Antibiotic was also given to treat the community acquired pneumonia that could be one of the possible etiology on this patient. Dietary modification with low fat diet and Ocreotide was also given to this patient as one of the treatment modalities. Discussion : The diagnosis of Chylothorax on this patient was established based on pleural fluid analysis and evidenced by lymphangiography examination by the presence of a leak in the thoracic lymphatic duct. Various modalities to  diagnose this condition have been carried out with inconclusive results. Non-pharmacological, pharmacological and radiological interventions with embolization through lymphangiography are proven to be able to stop leaks and reduce symptoms in this patient. Conclusion : Chyle leak to the pleural space may compress the lung and cause respiratory distress. Combinaton of thoracocentesis, embolization of the leakage, dietary intake modification and administration of ocreotide may help prevent further chylous fluid accumulation.
Rare Case: 65 Year Old Man with Anteromedial Mediastinal Tumor (Thymic Carcinoma) Mimicking Lung Cancer Lyono, Albert; Agus Setyawan, Ungky; Dwi Pratiwi, Suryanti; Rachma Erawati, Dini; Setyo Yudhanto, Hendy; Isharanto, Artono
Malang Respiratory Journal Vol. 8 No. 1 (2026): Volume 8 No 1, March 2026 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2026.008.01.02

Abstract

Background: Thymic carcinoma are very rare and often accompanied by metastases to other organs, pericardial effusion and pleural effusion where the 5-year survival rate is about 55%. Thymic carcinoma has several subtypes, squamous cell carcinoma and undifferentiated carcinoma. Case Report: A 65-year-old man coincidentally showed a mediastinal tumor on CXR while infected with COVID-19. Spirometry shows mild obstruction and restriction. Thorax CT scan suggests an anterior-middle mediastinal mass with left pleural effusion. The patient underwent a core biopsy followed by VATS tumor excision. Immunohistochemistry CK(+) and Vimentin(-) suggest a solid type adenocarcinoma, then Napsin A(-), TTF1(-), P40(+) suggest squamous cell carcinoma. The patient was diagnosed with left anteromedial mediastinal tumor (Thymic carcinoma: Squamous cell carcinoma) Masaoka stage III, left pleural effusion. The patient was treated with first line chemotherapy Carboplatin-Etoposide 6 series resulting stable disease followed by maintenance chemotherapy etoposide 6 series. The last RECIST suggests a solid malignant mass in the left lung (stable disease). Discussion: Surgery with radiotherapy is treatment for resectable cases but for unresectable cases chemotherapy with or without radiotherapy is preferred. The patient was unresectable case treated with chemotherapy. Thymic carcinoma has a poor response to chemotherapy with overall response rate around 22-36% but this patient has stable disease with chemotherapy. Conclusion: 65 years-old man without respiratory complaints diagnosed with unresectable thymic carcinoma and left pleural effusion, underwent chemotherapy with result stable disease up to 9 months continued maintenance therapy and become a resectable tumor. Keywords: Thymic carcinoma, Squamous Cell Carcinoma
53-year-old Woman with Sjögren's Syndrome and Anti-synthetase Syndrome Manifesting as Interstitial Lung Disease Krisdiyanto, Peter; Noor Chozin, Iin; Rakhma, Sastia; Rachma Erawati, Dini; Aditya Rahman, Perdana
Malang Respiratory Journal Vol. 8 No. 1 (2026): Volume 8 No 1, March 2026 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2026.008.01.01

Abstract

Background: Sjogren's Syndrome (SS) one of rare disease (approximately 1,0% population) that common manifest as Interstitial Lung Disease (ILD). This pathological condition has a poor prognosis, causes mortality, and is the most common complication. One of the systemic autoimmune diseases characterized by impaired function of the exocrine glands. Anti-synthetase syndrome (ASS) is an autoimmune condition, characterized by aminoacyl-transfer-RNA-synthetase antibodies accompanied by ILD, myositis, or arthritis. Case Report: A 53-year-old housewife was diagnosed with SS 3 years ago with osteoporosis and spinal compression. Complaints of dry skin, muscle weakness, back pain, joint pain, and shortness of breath after doing strenuous activities. History of treatment with Azathioprine 2 x 50 mg for 1 month and replaced with Mycophenolate mofetil (MMF) 2 x 360 mg after ILD was found on High-Resolution Computed Tomography (HRCT). Laboratory results showed anemia Hb 10.3, elevated CK-NAC levels (563 U/L), and positive anti-PL-7-Ab results. HRCT shows Usual Interstitial Pneumonia (UIP). Body-plethysmography results shows respiratory restriction (40%). Discussion: SS is identified by the presence of myositis-specific antibodies, accompanied by at least 2 conditions, ILD, inflammatory myopathy, or inflammatory polyarthritis. Anti-threonyl-tRNA-synthetase specific antibody (anti-PL-7) is one of the rarest. ILD presentation on HRCT helps identify SS or combination of ASS. The type of ILD that appears inpatients is a picture of UIP. Treatment of SS with Azathioprine is replaced with MMF after ILD is known and if progress is found, there is a place for giving anti-fibrotics. Conclusion: A 53-year-old woman with SS who found specific anti-PL-7 antibodies manifested ILD and inflammatory myopathy supports a combined diagnosis of ASS.
Rare Case: Enteric Type Lung Adenocarcinoma with Exon 21 Mutation Mimicking Thymic Adenocarcinoma: Rare Case: Enteric Type Lung Adenocarcinoma with Exon 21 Mutation Mimicking Thymic Adenocarcinoma Adolf Nggay, Andriana; Dwi Pratiwi, Suryanti; Jane Sugiri, Yani; Rachma Erawati, Dini; Setyo Yudhanto, Hendy; Elisabeth, Gracelia
Malang Respiratory Journal Vol. 8 No. 1 (2026): Volume 8 No 1, March 2026 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2026.008.01.04

Abstract

Background: Enteric type lung adenocarcinoma is a very rare variant of pulmonary adenocarcinoma, with a prevalence of about less than 1% of all cases(2). Due to the similarity in its symptoms, physical examination findings, and additional tests, it is very difficult to distinguish it from thymic adenocarcinoma, which can lead to delayed diagnosis and treatment(6). Case Report: A 58-year-old male presented with shortness of breath. Chest X-ray revealed a mass in the right suprahilar region, which was subsequently confirmed as a mediastinal tumor by contrast-enhanced chest CT scan. The patient underwent open thoracotomy biopsy, and macroscopic examination suggested thymic carcinoma. Histopathological findings revealed atypical cells with bronchoscopic washing and brushing cytology results classified as class II, and Ultrasound guided TTNA only showed debris cells. Diagnostic confirmation took 1.5 years, with immunohistochemistry results showing CK(+), CD45(-), P40(-), Vimentin(-), Napsin A(-), CK7(+), CK20(+), leading to a final diagnosis of enteric-type lung adenocarcinoma with EGFR exon 21 mutation. Conclusion: An accurate diagnosis of enteric-type pulmonary adenocarcinoma requires a multidisciplinary team approach and specific immunohistochemistry (CK7, CK20) to enable precise treatment planning. Keyword: Enteric Tipe Lung Adenocarcinoma, Thymic Adenocarcinoma, Immunohistochemistry
Rare and challenging case: a young woman with a pulmonary malignant peripheral nerve sheath tumor mimicking mesothelioma Irawan, Ari; Agus Setyawan, Ungky; Dwi Pratiwi, Suryanti; Setyo Yudhanto, Hendy; Kusuma Wardhana, Koernia; Rachma Erawati, Dini
Malang Respiratory Journal Vol. 8 No. 1 (2026): Volume 8 No 1, March 2026 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2026.008.01.03

Abstract

Introduction: Malignant peripheral nerve sheath tumor (MPNST) is a rare and highly aggressive tumor that develops from peripheral nerves which is closely related to neurofibromatosis type 1 (NF1). It has a very small percentage of occurrence in the lung. Here, we would like to report a case of pulmonary MPNST mimicking mesothelioma that was treated with cisplatin-pemetrexed. Case Illustrations: A 17-year-old female with no history of NF1, complaints of shortness of breath, and weight loss. A thoracic CT-scan and pathology were initially consistent with suspected mesothelioma. A unique finding in this case, was demonstrated positive vimentin and CD56, also loss of nuclear SOX10 and H3K27me3 expression in spindle cells. After a multidisciplinary board discussion, the diagnosis of MPNST was assumed. She underwent a palliative chemotherapy regimen. Discussion: Pulmonary MPNST with or without NF1 seems infrequent. Its clinical findings are usually nonspecific with a complex histological appearance. Establishing the diagnosis of MPNST is challenging, therefore pathological examination and immunohistochemistry (IHC) become the gold standard. The expression of SOX10 has poor sensitivity, also the loss of S100 expression may indicate de-differentiation of Schwann cells, hence, it may be less specific for MPNST diagnosis. Nevertheless, the loss of H3K27me3 marker has a great diagnostic value. The most effective treatment is complete surgical resection to achieve negative margins. However, in our case, the tumor has metastasized and is unresectable, so she was treated with the cisplatin-pemetrexed chemotherapy regimen and obtained stable disease results on the RECIST-CT examination after 3-series-chemotherapy. Conclusion: MPNST is a rare case with difficulties in diagnosis due to nonspecific clinical and histological features, therefore, IHC plays an important role in providing its diagnosis. Chemotherapy might be a good approach for treating an unresectable MPNST, but, still, there is no gold standard for palliative care guidelines.
Persistent Pneumothorax in Neurofibromatosis Type-1 Hustorio Aliongko Simamora; Susanthy Djajalaksana; Iin Noor Chozin; Dini Rachma Erawati; Hendy Setyo Yudhanto; Gracelia Ruth Elisabeth Damanik; Adinda Amalia Dani; Aditya Sri Listyoko
Jurnal Respirasi Vol. 12 No. 1 (2026): January 2026
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v12-I.1.2026.64-70

Abstract

Introduction: Neurofibromatosis type 1 (NF-1) is a rare autosomal dominant disorder. While typically recognized by its cutaneous features, pulmonary involvement, including apical cysts and basal interstitial fibrosis consistent with interstitial lung disease (ILD), can occur in up to 20% of patients. These manifestations create a predisposition to complications such as spontaneous pneumothorax. While this is relatively uncommon, occurring in approximately 1.5% of patients with NF-1, it represents a serious and potentially life-threatening complication when it does occur. Case: A 52-year-old male with a 20-pack-year smoking history and active pulmonary tuberculosis (TB) presented with acute chest pain and dyspnea. Dermatological examination and skin biopsy confirmed the diagnosis of NF-1. A high-resolution computed tomography (HRCT) scan of the chest revealed multiple subpleural pulmonary cysts consistent with NF-1-related ILD, alongside findings suggestive of active TB. The patient was diagnosed with a secondary spontaneous pneumothorax (SSP), which proved to be persistent despite initial chest tube drainage, ultimately requiring surgical intervention. Conclusion: This case highlights that NF-1 is a significant underlying risk factor for persistent pneumothorax, particularly when co-existing with other conditions like active TB and a history of smoking. The chronic inflammation and parenchymal destruction associated with these comorbidities can exacerbate the inherent structural lung abnormalities in NF-1, leading to complex, difficult-to-manage clinical scenarios. Early recognition of pulmonary manifestations in patients with NF-1 is crucial for anticipating and managing severe complications.
Co-Authors Adinda Amalia Dani Aditya Rahman, Perdana Aditya Sri Listyoko Aditya, Aldo Adolf Nggay, Andriana Agus Setyawan, Ungky Akbar, Jimmy Akbar Andri Andri Ari Irawan ARIFAH ARIFAH Astuti, Tri Wahyu Azmi, Mukhammad Binharyanto, Adlan Pratama Binharyanto Chozin, Iin Noor Chozin, Iin Nur Christian Surya Eka Putra Desfryda, Elynca Putri Djajalaksana, Susanthy Djanggan Sargowo Dwi Pratiwi, Suryanti Dwinadella, Sephia Eka Agustina, Dwi Rosa Elisabeth, Gracelia Elvira Sari Dewi Falyani, Silvy Amalia Gracelia Ruth Elisabeth Damanik Gregorio Satrio Pinunggul Handono Kalim hardiyanto, frenky Hendro Suryadi Hendy Setyo Yudhanto Hendy Setyo Yudhanto Hendy Setyo Yudhanto Hustorio Aliongko Simamora Iin Noor Chozin Imam Suseno Indah Sari, Fitri Isharanto, Artono Jane Sugiri, Yani Jani, Jane R Sugiri Jeffry Beta Tenggara Koernia Kusuma Wardhana Krisdiyanto, Peter Kristianto, Fransiskus Kristina Paskalita Kero Kusuma Wardhana, Koernia Kusworini Handono Listyoko, Aditya Sri Lyono, Albert Mahendra, Reza Aditya Maleachi, Reginald Mira Yuniarti Mohammad Faridza Setyo Hadikusumab Muhammad Zacky Hafiyyan Maulana Ngakan Putu Parsama Putra Noor Chozin, Iin Nurandhini, Marsha Nurdiana Nurdiana Nurima Diyah Oktavinayu Sari Latif Parsama Putra, Ngakan Putu Parsama, Ngakan Putu Putra Pratama, Mirza Zaka Pratiwi, Suryanti Dwi Pudjo, Herwindo Putri, Choirinnisa Meilia Ayu R. Sugiri, Yani Jane Rahayu Sartono, Teguh Rakhma , Sastia Rakhma, Sastia Retnani, Diah Prabawati Rezki Tantular Rezki Tantular Rini, Ni Made Rumaratu, Simon Petrus Hardiyanto santony, Santony Santoso, Agus Andreas Sari, Tita Luthfia Sastia Rakhma Semara Putra, Wayan Wahyu Setiadi, Satya Setiawan, Ungky Agus Setyawan, Ungky Agus Setyo Yudhanto, Hendy Sigiro, Rahel Margareth Febriana Soewondo, Widiastuti Sri Andarini Sugiri, Yani Jane R. Sugiri, Yani Jane Rosihaningsih Suryanti Dwi Pratiwi Susanthy Djajalaksana Susanthy Djajalaksana Susanti, Lia Sutedjo, Verawati Tantular, Rezki Tjakraatmadja, Ricardo Trimurtini, Asih Triwahju Astuti Ungky Agus Setyawan Wahono, Cesarius Singgih Wahyudy Prasetyo, Kevin Wantry, Kenty Wardhana, Koernia Kusuma Wardhana, Kurnia Winarni, Tika Wahyu Wisnu Barlianto Yani Jane R. Sugiri Yani Jane Sugiri Yudhanto, Hendi Setyo Yudhanto, Hendy Setyo Yusdianto, Adrian Yuyun Yueniwati Zaenal Kusuma