PMC3928752_01
99mTc-methylene diphosphonate bone scintigraphy showing diffusely increased left rib cage uptake (anterior a, posterior b; arrows). Transaxial single photon emission computed tomography (SPECT) and SPECT/CT images (c, e; arrows) show diffusely increased radiotracer uptake involving the left-sided ribs. Transaxial CT (bone window, d) shows normal left-sided ribs with regular cortical outlines. Transaxial CT (soft tissue window, f) shows a pleural-based soft tissue density lesion in the left lung lower lobe (f, arrow head) with diffuse circumferential pleural thickening (f, arrow)
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F1
It revealed diffusely increased radiotracer uptake involving all the left-sided ribs thus giving the appearance of asymmetrically increased left rib cage uptake [Figure 1a and b; arrows]. Transaxial SPECT and SPECT/CT images [Figure 1c and e; arrows] revealed diffusely increased radiotracer uptake in all the left-sided ribs. Using bone window on CT [Figure 1d], all the left-sided ribs showed regular cortical outlines with no apparent abnormality. Transaxial CT in soft tissue window revealed circumferential nodular left-sided pleural thickening [Figure 1f; arrow, arrow head].
Histological evaluation (x4, a; x10, b; x20, c) shows hematoxylin-and eosin-stained sections showing round to oval cell with moderate amount of cytoplasm with mild nuclear pleomorphism. Calretinin positivity (x40, d) is suggestive of malignant pleural mesothelioma
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F2
Biopsy from the pleural-based nodular lesion was suggestive of pleural mesothelioma [Figure 2a-d].