PMC5858840_01
(A) Chest contrast-enhanced CT scan in the sagittal planes indicate the tumor. (B) CT in the coronal planes before surgery showing a mass lesion in the anterosuperior mediastinum.. Abbreviations: CT, computed tomography; Eso, espohagus; Tra, trachea; TM, tumor.
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Chest computed tomography (CT) findings demonstrated a mass in the anterosuperior mediastinum (Figure 1).
(A) Microscopic appearance of the surgical specimen. Large lobules were composed of tumor cells closely spaced with fibrotic stroma of varying abundance and density (x40). Bar, 250 mum. (B) Uniform neoplastic cells with abundant, clear cytoplasm, nuclear atypia was not marked, and nuclear chromatin was finely dispersed, nucleoli were not prominent (x400). Bar, 25 mum. (C) Hyaline material is PAS-positive (x200). Bar, 50 mum. The neoplastic cells were positive for pan-cytokeratin (CKpan). (D) (x200), p63, (E) (x200), 34betaE12, (F) (x200). Bar, 50 mum. In contrast, neoplastic cells were negative for TTF-1 (G) (x200), GATA-3 (H) (x200), HMB45 (I) (x200). Bar, 50 mum.. Abbreviations: PAS, Periodic acid Schiff; TTF-1, thyroid transcription factor 1; GATA-3, GATA binding protein 3; HMB45, human melanoma black 45.
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Histopathological examination with H&E staining showed the tumor with a lobulated architecture composed of undifferentiated clear cells, with the abundance and density of fibrous stroma (Figure 2A). Figure 2B showed homogeneous neoplastic cells with abundant, clear cytoplasm, round or ovoid nuclei and a low nuclear/cytoplasmic ratio. Mucicarmine stain was negative in this case when tested, while the material was positive for Periodic acid Schiff (PAS) (Figure 2C). The neoplastic cells were positive for CKpan, p63 and 34betaE12 (Figure 2D-F). In contrast, neoplastic cells were negative for TTF-1, GATA-3 and HMB45 (Figure 2G-I), and histological examination from left breast tumor demonstrated the typical breast infiltrating ductal carcinoma.