PMC8380843_01
Chest computed tomography (CT) scans of the patient during the follow-up. (A) Before the 125I seed implantation, contrast-enhanced CT images in lung windows (upper) and mediastinal windows (lower) show 5 enhanced nodules (white arrowheads) in both lungs. (B) Six months, 1 year, and 7 years after 125I seed implantation, unenhanced CT images in mediastinal windows show that volume of lesions was significantly reduced within 1 year and remained stable for 7 years. High-density 125I seeds were located in the original sites of the lesions.
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There were five enhanced nodules, including a 2.5 x 2.3-cm lesion in the right lower lobe, a 2.2 x 1.8-cm lesion in the right middle lobe, and three 1.0 x 1.0-cm lesions in the left lobes (Figure 1A). Tumors version 1.1 (RECIST v1.1) 6 months later, and further shrank 1 year later (Figure 1B). Thereafter, the patient was followed up with CT scans annually and her disease remained stable for 7 years as of the last follow-up on October 25, 2020.
Histopathological examination shows the pulmonary nodules were metastatic pheochromocytoma. (A) Hematoxylin and eosin staining of biopsy specimens shows nests of tumor cells separated by vascular septa (Zellballen). (B) Chromogranin and (C) synaptophysin immunostaining is diffuse strong positive in the tumor cells. (D) CD56 immunostaining is positive in the membrane of the tumor cells. (E) Ki-67 immunostaining shows approximately 5% of cells are positive. Original magnification x 200.
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Histopathological examination confirmed the diagnosis of metastatic pheochromocytoma (Figure 2).