PMC3697234_01
A chest plain radiograph (X-ray) showing bilateral pleural effusion, partial bibasilar atelectasis, and linear pleural calcifications involving the right lung.
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A chest plain radiograph (X-ray) showed bilateral pleural effusion, partial bibasilar atelectasis, and linear pleural calcifications involving the right lung (Figure 1).
An axial chest, abdominal, and pelvic contrast-enhanced computed tomography (CT) scan showing bilateral pleural effusion, partial bibasilar atelectasis, and peripheral dense calcifications of the right lung. In addition, two pleural masses touching the right hemidiaphragm were identified and measured 3.2 x 2.1 cm and 4.3 x 4.8 cm (white arrows). The masses were suspicious for neoplastic lesions. No axillary or mediastinal lymphadenopathy was identified. Furthermore, no evidence of distant metastasis was identified.
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Furthermore, no evidence of distant metastasis was identified (Figure 2).
An axial chest positron emission tomography/computed tomography (PET/CT) scan showing two hypermetabolic fluorodeoxyglucose- (FDG-) avid mass lesions involving the right diaphragmatic pleura, suggestive of neoplastic lesions (white arrows).
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Whole-body positron emission tomography/computed tomography (PET/CT) scan showed two hypermetabolic fluorodeoxyglucose- (FDG-) avid lesions involving the right diaphragmatic pleura, suggesting neoplastic lesions and supporting the earlier pathological CT scan and CT-guided needle-core biopsy findings (Figure 3).
(a) Histopathological examination of the right diaphragmatic pleural masses (magnification power, 40x) showing the neoplastic cells that grew mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. The neoplastic proliferation consisted of highly atypical large epithelioid cells with abundant eosinophilic cytoplasm, round to oval nuclei with marked pleomorphism, vesicular chromatin, and prominent single nucleoli. (b) Focal hemorrhagic areas were identified.
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The neoplastic cells grew mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells (Figure 4(a)). In addition, focal hemorrhagic areas were also identified (Figure 4(b)).
Immunohistochemical examination of the resected right diaphragmatic pleural masses. (a) Tumor cells stained positive for vimentin (magnification power, 40x). (b) Tumor cells stained positive for CD31 (magnification power, 40x). (c) Tumor cells stained positive for CD68 (magnification power, 40x). (d) Tumor cells stained positive for Fli-1 (magnification power, 40x).
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Immunohistochemical analysis showed strong positivity for mesenchymal (vimentin) and endothelial (CD31, CD68, and Fli-1) markers (Figures 5(a)-5(d)).