PMC5398116_01
Computed tomography scan (axial section) of thorax showing a large heterogeneously enhancing soft tissue mass lesion in the right perihilar region involving right lower lobe extending into the mediastinum with loss of fat planes with esophagus, aorta, and right crus of the diaphragm. There is no chest wall or pleural involvement
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F1
Computed tomography scan of chest [Figure 1] showed an 11.3 cm x 11 cm x 10 cm soft tissue mass lesion in right perihilar region with the loss of fat planes with esophagus, aorta, and diaphragm without chest wall or pleural involvement.
Biopsy from lung lesion showing small round cells with scanty cytoplasm with condensed chromatin and inconspicuous nucleoli (H and E, x200)
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F2
Biopsy showed atypical round to oval cells with scanty cytoplasm intermixed with respiratory epithelium [Figure 2].
Immunohistochemistry picture from lung lesion showing tumor cells positive for neuron specific enolase (x200)
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F3
Immunohistochemistry (IHC) was positive for neuron-specific enolase (NSE) [Figure 3], synaptophysin, chromogranin, CD 99, and vimentin.
Magnetic resonance imaging brain (a = coronal section and b = axial section) showing a solitary lesion with areas of altered signal intensity at right periventricular and periatrial parietal lobe with significant perilesional edema suggestive of hemorrhagic metastatic deposit
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F4
MRI brain [Figure 4] showed an 8.6 cm x 7.5 cm solitary lesion with areas of altered signal intensity at right periventricular and periatrial parietal lobe with significant perilesional edema suggestive of hemorrhagic metastatic deposit.
Immunohistochemistry picture from brain metastasis showing tumor cells positive for (a) synaptophysin (x100), (b) chromogranin (x200), (c) vimentin (x100), (d) CD 99 (x200)
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F5
IHC was positive for synaptophysin [Figure 5a], chromogranin [Figure 5b], vimentin [Figure 5c], and CD 99 [Figure 5d] with Ki67 of 90% while negative for CK, TTF-1, and melan-A which suggested metastasis from primary PNET lung.