PMC3685364_01
Tumor shadow in the left lung
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His chest X-rays showed a tumor shadow presenting in the left lung field (arrow in Fig. 1).
Lobulated mass in the left hilum and even the left pulmonary artery
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Chest computed tomography (CT) scan revealed a lobulated mass occupying the left hilum and even stretching mediastinal structures including the left pulmonary artery (arrow in Fig. 2).
Histological analysis of the resected tumor specimen A) Tumor cells were pleomorphic, irregular, ovoid, or spindle-like in shape, and some of them had an indistinct cell boundary. The tumor was composed of compact cells arranged in cords (HE, magnification 200x). B) A higher magnification of the sarcomatoid component (HE, magnification 400x)
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Importantly, severe necrosis was found inside (Fig. 3).
Immunohistochemical staining of the resected tumor specimen. There was positive expression of: A) EMA, B) CK, and C) vimentin, but negative expression of D) TTF-1, E) SMA, and F) cytokeratin 5/6
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Immunohistochemically, the tumor cells were positive for epithelial membrane antigen (EMA) (Fig. 4A), creatine kinase (CK) (Fig. 4B), and vimentin (Fig. 4C). They were negative for thyroid transcription factor-1 (TTF-1) (Fig. 4D), smooth muscle actin (SMA) (Fig. 4E), and cytokeratin 5/6 (Fig. 4F).