PMC6702405_01
Posteroanterior chest X-ray (left) and magnifications of the upper (white box) and lower (purple box) lobes of the right lung show the two pulmonary opacities (white and purple arrows). Note that the opacity of the upper lobe (white arrow and white box) is fainter than that of the lower lobe (purple arrow and purple box) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).
gr1.jpg
PMC6702405_01_gr1.jpg
fig0005
The chest radiograph revealed two pulmonary opacities located in the upper and lower lobes of the right lung (Fig. 1).
Axial CT image with lung window setting (A) displays the nonsolid nodule in the right upper lobe (arrow). There is no evidence of the pulmonary nodule on axial CT image with mediastinal window setting (B).
gr2.jpg
PMC6702405_01_gr2.jpg
fig0010
The nodule in the right upper lobe had a subsolid consistency (nonsolid nodule) and a maximum diameter of 15 mm (Fig. 2).
Axial CT image with lung window setting (A) displays the solid nodule in the right lower lobe (arrow). Precontrast (B), late arterial phase (C), and portal venous phase (D) images of the upper abdomen show the contrast-enhancement of the pulmonary nodule (curved arrows).
gr3.jpg
PMC6702405_01_gr3.jpg
fig0015
The nodule located in the right lower lobe had a solid consistency (solid nodule), a well-defined margin and a maximum diameter of 19 mm (Fig. 3). The solid nodule also exhibited a significant contrast-enhancement (Fig. 3).
Cropped axial CT images with the lung window setting showing the nonsolid (A) and solid (D) pulmonary nodules. (B, C) Histological hematoxylin and eosin (H-E) images of the nonsolid pulmonary nodule at the actual size (B) and at 10x (C) showing the neoplastic cell growth along the alveolar septa with the partial effacement of the alveolar architecture, which reflected the nonsolid appearance of this nodule on CT images. Note that some alveolar spaces are still recognizable. (E, F) Histological H-E images of the solid pulmonary nodule at the actual size (E) and at 20x (F) display the complete effacement of the alveolar architecture, which reflected the solid appearance of this nodule on CT images. Both pulmonary nodules were made by epithelioid malignant cells that were consistent with melanoma cells (C, F).
gr4.jpg
PMC6702405_01_gr4.jpg
fig0020
However, these two pulmonary nodules also had a different morphological pattern of presentation on histologic images (Fig. 4). In the subsolid nodule, the neoplastic cells exhibited infiltrative growth that mainly occurred along the alveolar septa, with the partial sparing of the alveolar architecture (Fig. 4B and C). In the solid nodule, the neoplastic cells replaced the alveolar architecture with the complete effacement of the alveolar spaces (Fig. 4E and F).