PMC9316617_01
Physical examination showed an erythematous rash and swelling surrounding a skin mass on the right abdomen (A, arrows). Magnetic resonance imaging shoed an inhomogeneous soft tissue mass approximately 10 cm in diameter (B, coronal T2-weighted image; C, axial fat saturation T2-weighted image). The lesion also showed markedly restricted diffusion on diffusion-weighted sequences (D, arrow).
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Physical examination showed a raised skin mass surrounded by swelling and erythema on the right abdomen (Figure 1A). T2-weighted sequences (Figures 1B, C) and exhibited markedly restricted diffusion on diffusion-weighted sequences (Figure 1D).
A large mass showing hypermetabolism peripherally and hypometabolism centrally was found on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (A), arrows. Hypermetabolic lesions were imaged in the right lung and the posterior pleural wall (arrows) on axial computed tomography (B, C), positron emission tomography (D) and fusion imaging (E).
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The mass was suspected to be a sarcoma. To investigate potential distant metastases, 18F-fluourodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) was performed, which showed the previously demonstrated large abdominal mass was hypermetabolic in the periphery and hypometabolic in the center (Figure 2A); other hypermetabolic lesions were shown in the right lung and the posterior pleural wall (Figure 2B-E).
Hematoxylin and eosin staining revealed the tumor was composed of abundant oval and plump cells with enlarged nuclei and red, broad cytoplasm (A). Immunohistochemical staining for CK 7 (B) showed a strong and diffuse brown cytoplasmic reaction. TTF-1 staining (C) Showed strong nuclear staining of tumor cells. Immunohistochemical analysis showed PDL-1 expression (D).
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Examination of hematoxylin and eosin-stained specimen (Figure 3A) revealed abundant oval and plump cells with enlarged nuclei and red, broad cytoplasm. TTF-1 (Figure 3C), and PCK but negative for P63, CK20, Villin, ER, CDX2, HER2, P16, GATA-3, and VT-1. This suggested a diagnosis of primary pulmonary adenocarcinoma with metastasis. Because PDL-1 was expressed (Figure 3D) and EGFR mutation was not detected, the patient was placed on bevacizumab plus pemetrexed-platinum doublet chemotherapy.