PMC8512626_01
Chest CT images of the patient.. (A) At diagnosis of pulmonary tumor embolism. Emerging wedge-shaped nodules in the subpleural zones of the left lower lobe (arrowheads) and diffuse ground-glass opacities in both lower lobes were detected. (B) Two and a half months after the diagnosis of PTE. The patient received three cycles of paclitaxel and bevacizumab. Chest CT images revealed shrinkage of multiple wedge-shaped nodules and disappearance of ground-glass opacities.
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Repeated chest CT images showed emerging wedge-shaped nodules in the subpleural zones of the left lower lobe and diffuse ground-glass opacities in the bilateral lower lobes (Fig. 1A). Two and a half months after the diagnosis of PTE, chest CT imaging revealed shrinkage of multiple wedge-shaped nodules and disappearance of ground-glass opacities (Fig. 1B), indicating the efficacy of chemotherapy.
Pulmonary perfusion-ventilation scintigraphy.. Pulmonary ventilation scintigraphy (81mKr) showed no abnormalities, whereas pulmonary perfusion scintigraphy (99mTc-MAA) showed multiple small wedge-shaped defect areas (arrowhead) on the peripheral sides of both lungs.
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Pulmonary ventilation scintigraphy (81mKr) showed no abnormalities, while pulmonary perfusion scintigraphy (99mTc-MAA) showed multiple small wedge-shaped defect areas on the peripheral sides of both lungs (Fig. 2).
Pulmonary artery aspiration cytology.. (A) 3D pulmonary artery imaging (red) reaching the nodules (blue) reconstructed from chest CT scanning. (B) The Swan-Gantz catheter was advanced and aspiration in the vicinity of each nodule was performed from selected branches of left A8 and A9. Arrowheads indicate the pulmonary artery reaching the nodules. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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We then performed selective aspiration cytology from the left pulmonary arteries, referring to 3D pulmonary artery imaging, reaching the nodules (Fig. 3A). We advanced the Swan-Gantz catheter and performed four aspirations in the vicinity of each nodule (Fig. 3B).
Pathological examinations of cells aspirated from selected pulmonary arteries.. (A) Hematoxylin and eosin (HE) staining and (B) Papanicoloau staining showed cancer cells with a heavy accumulation having an increased N/C ratio, increased chromatin, and slightly pale cytoplasm. (C) Immunohistochemistry staining for CK7.
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Pathological examination showed cancer cells with heavy accumulation with an increased N/C ratio, increased chromatin, and slightly pale cytoplasm (Fig. 4A and B). Immunohistochemistry staining revealed CK7(+) (Fig. 4C) and CK20(-).