Askin’s tumor is a rare neoplasm of the chest wall with a dismal prognosis and is usually observed in young subjects. We describe a 15-year-old female with massive hemoptysis who had an extensive thoracopulmonary tumor on chest CT. She underwent bronchoscopy which showed the location of the tumor in the bronchus intermedius. The biopsy obtained from the tumor enabled a diagnosis of Askin’s tumor to be made. After induction of chemotherapy, hemoptysis stopped and her constitutional symptoms improved. We focus on the clinical features, imaging, and histopathological characteristics of Askin’s tumor.

WHAT IS YOUR DIAGNOSIS?A twenty-year-old woman was admitted due to non-massive hemoptysis and low grade fever from a few days earlier. She reported productive cough, no chills, no chest pain and no shortness of breath. On admission, she was stable with mild fever and no respiratory distress or tachypnea; the remainder of physical examinations was normal.She mentioned a history of diabetes mellitus type one (DM1) since a few years ago. Surprisingly, she was on oral agents for DM1. She was well until approximately a month ago when she developed episodes of unconsciousness and she was admitted to a hospital with diabetic ketoacidosis. After intensive care, the patient was discharged in an improved condition.She was a single employee, with no travel history in recent months. She was neither a drinker nor a smoker and was not using any illicit drugs. Allergic history was unremarkable.Laboratory analysis showed normal complete blood cell and differential counts, electrolyte levels and renal and liver function tests with 250 mg/dl random glucose level. Analysis of arterial blood gases revealed no acidosis and urinalysis showed no ketonuria.

Hemoptysis in the patients suffered from pulmonary tuberculosis (TB) may be resulted by active TB or the complications of such disease which appears as bronchiectasis, fungal lesions deployed in tuberculosis cavities or Rasmussen aneurysm, Bronchiolitis or relapse and sometimes, it may be considered as caused by reasons irrelevant to TB. In this report, the patient is a 69-year-old man as complained of hemoptysis with a treated TB experience that was found as normal in the preliminary review of X-ray and CT. During bronchoscopy, a live leech (bloodsucker) was found in hypopharynx area that was swallowed after repeated attempts to remove it through the gastrointestinal tract and its suction signs were appeared as a mucosal mass in the hypopharynx area. The patient had no symptoms during his stay in the hospital.