PMC5167281_01
An axial contrasted computed tomography scan of the chest showing enlarged main pulmonary trunk suggesting pulmonary hypertension and extensive mediastinal lymphadenopathy.
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Significantly, the CT scan did not show evidence of intraluminal pulmonary thrombi or features of parenchymal lung disease (Fig. 1).
Microscopic slides of sections of the lungs showing intravascular collections of fibrin and markedly anaplastic tumour cells consistent with poorly differentiated adenocarcinoma. (A) A slide showing tumour cells with associated thrombus in the pulmonary vessels (arrows). Haematoxylin and eosin stain. Original magnification 100x. (B) A slide showing recanalization of a thrombosed pulmonary blood vessel. Note the individual tumour cells (arrows). Haematoxylin and eosin stain. Original magnification 200x. (C) A slide illustrating intracytoplasmic mucin vacuoles in tumour cells (arrows). Periodic acid-Schiff stain treated with diastase. Original magnification 400x. (D) A slide illustrating positive staining (brown stain) of tumour cells with an immunohistochemical stain (cytokeratin cocktail) for AE1/AE3 in keeping with a carcinoma rather than a lymphoma or melanoma. Original magnification 100x.
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Examination of the lungs demonstrated multiple organized tumour emboli occluding the pulmonary vessels (Fig. 2).