PMC4142298_01
CT chest: right lung lower lobe peripheral mass.
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His chest radiograph and computerized tomography (CT) scan (Figure 1) showed a right lung lower lobe heterogeneous mass (3.9 x 3.3 x 3.2 cm) and right middle lobe atelectasis without pleural effusion.
Circumscribed solid tumor mass surrounded by lung tissue.
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Its cut surface was heterogeneously gray-white with focal areas of hemorrhages and cartilaginous tissue (Figure 2).
Islands of mature and immature hyaline cartilage. H&E: x100.
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Microscopically, it was composed of many lobules of hyaline cartilage (Figure 3) in which the constituent chondrocytes varied from bland to moderately pleomorphic (Figure 4) with areas of necrosis (10%).
Interface of chondrosarcoma and rhabdomyosarcoma. H&E: x200.
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Microscopically, it was composed of many lobules of hyaline cartilage (Figure 3) in which the constituent chondrocytes varied from bland to moderately pleomorphic (Figure 4) with areas of necrosis (10%).
Nodules of blastema-like cells separated by loose tissue. H&E: x100.
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The intervening stroma varied from blastema-like to fibromyxoid to dense spindle cell type (Figure 5), harboring an occasional microscopic cyst lined by ciliated cuboidal to columnar cells with subepithelial condensation of blastema-like to spindle shaped neoplastic cells (Figure 6).
Ciliated columnar epithelium lining the microcyst and underlying condensation of small round cells. H&E: x200.
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The intervening stroma varied from blastema-like to fibromyxoid to dense spindle cell type (Figure 5), harboring an occasional microscopic cyst lined by ciliated cuboidal to columnar cells with subepithelial condensation of blastema-like to spindle shaped neoplastic cells (Figure 6).
Anaplastic large bizarre cells amidst malignant pleomorphic cells. H&E: x200.
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There were focal areas of skeletal muscle differentiation, bizarre multinucleate giant cells, and many scattered mitoses throughout (Figures 7 and 8).
Scattered ovoid eosinophilic rhabdomyoblasts. H&E: x200.
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There were focal areas of skeletal muscle differentiation, bizarre multinucleate giant cells, and many scattered mitoses throughout (Figures 7 and 8).
Desmin: cytoplasmic staining: x400.
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Immunohistochemically, the rhabdomyoblasts were positive for Desmin and muscle specific actin (MSA) (Figures 9 and 10).
MSA: cytoplasmic staining: x200.
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Immunohistochemically, the rhabdomyoblasts were positive for Desmin and muscle specific actin (MSA) (Figures 9 and 10).
S100: nuclear staining in cartilage tissue: x200.
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The chondrocyte nuclei were positive for S100 (Figure 11) and the epithelium lining the cysts was positive for CK19 (Figure 12).
CK19 cytoplasmic staining of cyst lining epithelial cells: x200.
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The chondrocyte nuclei were positive for S100 (Figure 11) and the epithelium lining the cysts was positive for CK19 (Figure 12).
MRI brain: large right frontal lobe mass.
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CT done three months earlier) with central area of necrosis causing compression of the ipsilateral lateral ventricle and significant midline shift (Figure 13). Craniotomy was performed and the resected mass was received in the laboratory as multiple fragments collectively measuring 7 x 5 x 1 cm.
Metastatic sarcoma and edematous brain tissue interface. H&E: x200.
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Microscopically, the tumor was composed of dense spindle cell proliferation with areas of hemorrhages, necrosis, and scattered anaplastic bizarre giant cells (Figure 14).
Brain metastasis, Desmin cytoplasmic staining: x400.
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The tumor cells were positive for Desmin and MSA (Figure 15).