PMC7434324_01
Contrast enhanced chest CT showing left-sided pleural thickening without contrast-enhancement and left-sided pleural effusion in pockets.
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Contrast enhanced CT showed left-sided pleural thickening without contrast-enhancement, moderate left-sided loculated pleural effusion, an enlarged 12mm mediastinal lymph node at station 8 and an osteolytic process in Th10 (shown in Fig. 1).
PET-CT showing increased uptake in the left pleura, in multiple pathological lymph nodes over and under the diaphragm and in the skeleton.
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A Fluorine-18-labeled fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET)-CT showed increased FDG uptake in the left pleura, multiple metabolic active lymph nodes in the cervical and mediastinal region and under the diaphragm and increased FDG uptake in the skeleton (shown in Fig. 2).
Histopathologic findings showing epithelioid hemangioendothelioma. A: Hematoxylin and eosin stain showing malignant cells with intra-cytoplasmic vacuoles. B: Positive immunostaining for CD 31.
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Ultrasound-guided closed pleural biopsy, 18G, from the PET-positive, left dorsal parietal pleura showed malignant cells, some with intra-cytoplasmic vacuoles, and immunohistochemistry positive reaction to CD31 and CD34, suggesting pleural epithelioid hemangioendothelioma (shown in Fig. 3).