PMC4681899_01
Chest X-ray showing diffuse bilateral airspace disease with right-sided pleural effusion.
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His initial Chest radiograph showed bilateral diffuse infiltrates with blunting of bilateral costophrenic angles (Fig. 1).
Chest CT showing: (A) bilateral multifocal areas of consolidation, numerous cavitary nodules, and ground glass opacities; (B) partially obstructed right middle lobe bronchus; (C) mixed sclerotic and lytic lesion in the posterior part of T-11 vertebrae.
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There were multiple bilateral cavitary nodules and an incidental lytic lesion was identified in the T-11 vertebrae (Fig. 2).
Bronchoscopic findings showing: (a) medium-sized partially obstructing fungating infiltrative lesion in the right middle lobe; (b) two non-obstructing polypoid lesions in the left lower lobe.
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(a) Histological evaluation with hematoxylin and eosin stain showing spindle and epithelioid tumor cells in myxohyaline stroma with necrosis and tumor cells with pleomorphic hyperchromatic nuclei and prominent nucleoli. Immunohistochemical analysis was positive for: (b) cytokeratin AE1/AE3; (c) CD31; (d) ETS-related gene (ERG).
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His endobronchial biopsy showed a high grade epitheloid hemangioendothelioma (Fig. 4).