PMC6122389_01
Portable Chest X-ray on presentation.
gr1.jpg
PMC6122389_01_gr1.jpg
fig1
Chest x-ray (Fig. 1) showed a widened mediastinum.
(a): Chest CT angiogram demonstrating a 3.0 x 1.5 cm mass in the anterior medial right upper lobe of the lung. (b): Chest CT angiogram demonstrating mediastinal and right hilar lymphadenopathy.
gr2.jpg
PMC6122389_01_gr2.jpg
fig2
Computed tomography of the chest (Fig. 2, Fig. 3) revealed a 3 x 1.5 cm mass in the right upper lobe suspicious for malignancy, extensive metastatic mediastinal and hilar lymphadenopathy resulting in narrowing of the superior vena cava, and innumerable hepatic metastases.
(a): Chromogranin A (liver biopsy) immunostain is focally and weakly positive in the cytoplasm (brown color). Chromogranin A can stain weaker in SCLC than in typical carcinoid tumors. (b): Synaptophysin (liver biopsy) immunostain is diffusely and moderately positive in the cytoplasm (brown color). Synaptophysin can stain weaker in SCLC than in typical carcinoid tumors. (c): CD56 (liver biopsy) immunostain is diffusely and strongly positive in the cytoplasm (brown color). CD56 is the most sensitive for SCLC and the least specific marker for other tumor sites. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
gr4.jpg
PMC6122389_01_gr4.jpg
fig4
Liver biopsy (Fig. 4a/b/c) was performed and revealed metastatic small cell carcinoma.