PMC7118409_01
A, Chest X-ray showed a sole nodular lesion (arrow) adjacent to heart in right lower lung fields. B and C, Chest contrast-enhanced computed tomography shows a multiloculated cystic heterogeneous mass (arrow) in anterior mediastinum. D, A multiloculated cystic heterogeneous mass is also shown in liver (arrow). E, A positron emission tomography revealed a higher standardized uptake value of the mediastinal mass (arrow).
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Chest X-ray showed a sole nodular lesion adjacent to heart in right lower lung field, and contrast-enhanced computed tomography revealed a multiloculated cystic heterogeneous mass in anterior mediastinum and liver (Fig. 1A-D). A positron emission tomography revealed a higher standardized uptake value, ranging 2.6 to 4.2 of maximum value, of cystic wall, suggesting a possibility of malignancy in the lesion (Fig. 1E).
A, Specimen form video-associated thoracic surgery (VATS) shows papillary structures of atypically cuboidal and columnar epithelial cells and psammoma body. (Hematoxylin and eosin (HE) stain, x40). B, Pathological findings of specimens from ovary of the initial gynecologic surgery match with those of specimens from VATS (HE stain, x40). C and D, Specimens from VATS show positive immunoreactivity of both Cytokeratin (CK) 7 and CK 20 (x40).
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Pathological examination of the specimens from VATS revealed malignant cells lying in a cuboidal and columnar epithelial layer with focal papillary growth and psammoma body (Fig. 2A). Pathological findings of the specimens from ovary of the initial gynecologic surgery matched with those of specimens from VATS (Fig. 2B). Cytokeratin (CK) 7 and CK 20, all specimens demonstrated positive immunoreactivity in the present case (Fig. 2C and D). Collectively, these pathological findings suggested that mediastinal metastasis arose from ovarian cancer at 29 years after initial gynecologic surgery and chemotherapy.