PMC7166291_01
Noncontrast CT chest, coronal view. Visible is a 1.5 cm tumor mass in the right upper lobe of the lung.
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He presented with progressive shortness of breath and underwent a workup with CT scan of the chest without contrast, which revealed two distinct appearing tumors, one in the right upper lobe with a tumor size of 1.5 cm and another in the right lower lung with a tumor size of 13 cm (see Figures 1 and 2).
Noncontrast CT chest, coronal view. Visible is a 13.0 x 12.8 x 7.5 cm tumor mass in the right lower lobe of the lung.
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fig2
He presented with progressive shortness of breath and underwent a workup with CT scan of the chest without contrast, which revealed two distinct appearing tumors, one in the right upper lobe with a tumor size of 1.5 cm and another in the right lower lung with a tumor size of 13 cm (see Figures 1 and 2).
Hematoxylin and Eosin staining, low-power 100x view of adenocarcinoma. Tumor shows an acinar growth pattern.
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The right upper lobe tumor was a moderately differentiated lung adenocarcinoma, stage pT2a (see Figure 3).
Hematoxylin and Eosin, low-power 100x view of solitary fibrous tumor. Mesenchymal neoplasm comprised by spindled cells embedded within a collagen matrix. The tumor is fed by a mixture of small slit-like vessels and large ectatic vessels with a characteristic "staghorn" appearance.
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This tumor showed a fascicular pattern of spindled cells with elongated nuclei (see Figure 4).
Hematoxylin and Eosin, high-power 500x view of solitary fibrous tumor. Four mitotic figures identified within a single high-power field.
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The mitotic rate was significantly elevated at 13 mitotic figures per 10 high-power fields (see Figure 5).
T1 postgadolinium MRI brain with axial view. This reveals a peripherally enhancing and centrally necrotic appearing mass in the left frontoparietal lobe with surrounding edema.
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MRI of the brain showed a solitary 2.5 cm enhancing mass of the left posterior frontal lobe, just anterior to the motor cortex, with extensive surrounding edema (see Figures 6 and 7).
T1 postgadolinium MRI brain with coronal view. This reveals a peripherally enhancing and centrally necrotic appearing mass in the left frontoparietal lobe with surrounding edema.
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fig7
MRI of the brain showed a solitary 2.5 cm enhancing mass of the left posterior frontal lobe, just anterior to the motor cortex, with extensive surrounding edema (see Figures 6 and 7).
Postresection, T1 postgadolinium MRI brain with axial view. This reveals postsurgical changes after a gross total resection of the left frontoparietal mass with residual edema in the tumor bed.
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fig8
The patient underwent left frontal craniotomy with gross total tumor resection, as shown on postoperative MRI (see Figures 8 and 9) without complications.
Postresection, T1 postgadolinium MRI brain with coronal view. This reveals postsurgical changes after a gross total resection of the left frontoparietal mass with residual edema in the tumor bed.
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fig9
The patient underwent left frontal craniotomy with gross total tumor resection, as shown on postoperative MRI (see Figures 8 and 9) without complications.
Hematoxylin and Eosin, low-power 100x view of metastatic solitary fibrous tumor. The tumor again shows a mixture of small slit-like vessels and large ectatic vessels with a characteristic "staghorn" appearance.
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fig10
The mitotic rate was significantly elevated at 13 mitotic figures per 10 high-power fields (see Figure 5). The tumor matrix was predominantly myxoid, and the cells were fed by a rich vascular network of small slit-like vessels and large ectatic branching vessels (see Figure 10).
Multiple views of the Gamma Knife treatment plan with 22 Gy prescribed to the periphery of the tumor cavity, and this correlates with the 50% isodose line (dose representations are overlayed on a brain MRI from the day of treatment).
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fig11
He underwent single fraction Gamma Knife radiosurgery to the tumor cavity with a prescription dose of 22 Gy to the 50% isodose line (see Figure 11).