PMC8216226_01
The chest X-ray showed a large dense shadow with an unclear boundary in the left lung field, and the heart was obviously compressed and shifted to the right.
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A chest X-ray plain examination revealed a large and dense shadow in the left lung field, and the heart was compressed and shifted to the right (Figure 1).
(a) Chest CT mediastinal window showed a huge soft-tissue density mass shadow in the left mediastinum, with unclear boundary, multiple nodular low-density areas (black arrow), and speckled high-density calcification foci (white arrow). (b) Contrast-enhanced CT revealed mild heterogeneous enhancement of the lesion, with nodular nonenhanced necrotic area (white arrow). (c) CT image of chest in coronal position. This coronal contrast-enhanced chest CT image clearly shows the extent of the mass, with the mediastinum slightly shifted to the right by the compression of the tumor (white arrow).
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The computed tomography (CT) image shows a large mass of soft tissue with uneven density in the mediastinum to the left thoracic cavity (Figure 2).
Hematoxylin-eosin staining (a), 40 times magnification: microscopically, there were obviously degenerate fusiform and ovoid tumor cells with loose reticular arrangement, hyperchromatic nuclei, inconsistent cell sizes, and can see the fat composition between the cells. Immunohistochemical staining showed tumor cells positive for AFP (b), CK (c), CD117 (d), glypican-3 (e), SALL4 (f), vimentin (g), and Ki-67 (h).
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The pathological and immunohistochemical images are shown in Figure 3.
(a) PET/CT examination of the patient with mediastinal MGCT after chemotherapy; whole-body MIP (maximum density projection) images showed large patches of slightly increased radioactivity uptake in the left lung field (black arrow), SUVmax 5.2. (b) Axial PET/CT fusion images showed varying levels of uptake of radioactive tracers in the lesions, but no uptake in the cystic necrosis area (white arrow). (c) Coronal PET/CT fusion image.
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PET/CT examination to evaluate the treatment effect. PET/CT showed that the tumor volume was not significantly reduced compared to before treatment (Figure 4), but no obvious systemic metastasis was observed.