PMC5582536_01
A 60-year-old gentleman, with a history of 6 months on and off blood stained sputum, was admitted for an episode of massive hemoptysis. (a) Selected axial image of urgent computed tomography thorax (lung window) showed focal consolidation with multiple small centrilobular nodules and adjacent ground glass changes (arrow). (b) Selected coronal image of computed tomography thorax could appreciate the adjacent ground glass changes around the focal consolidation at left upper lobe (arrow).
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F1
Focal consolidation with multiple small centrilobular nodules and adjacent ground glass changes were found [Figure 1a and b]. In areas, adenomatoid tumor arrangement, ill-formed ectatic vascular channel formation, and hemorrhagic microcystic arrangement with mitotic figures up to 1.5 per 10 high-power fields.
(a) With repeated hemoptysis, investigation with high resolution computed tomography after a month (selected axial image) showed the left upper lobe mass is significantly enlarged (arrow). (b) Selected coronal image of high resolution computed tomography could appreciate the ground glass halo around the enlarged lung mass (arrow).
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F2
He was followed up with high-resolution CT after a month, showed an enlarged left upper lobe mass surrounding by a ground glass halo [Figure 2a and b] Neoplasm had to be considered.
Histopathological examination of lobectomy of left upper lobe. (a) Showed hemorrhage into the bronchiole (arrow). It correlated with the computed tomography images of ground glass changes around the mass. (b) Histopathological examination showed the tumor comprised sheets of loosely cohesive malignant tumor cells which had eccentric markedly pleomorphic nuclei, prominent nucleoli, vesicular with the presence of fine strands of chromatin, and moderate amount of eosinophilic cytoplasm.(high power). (c) Tumor cells stained positive for ERG, a vascular-specific marker (magnification power, x100). (d) Tumor cells stained positive for CD31, a vascular-specific marker (magnification power, x40).
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F3
The sections showed an infiltrative hemorrhagic tumor, which eroded the bronchus and was associated with bronchial luminal hemorrhage and diffuse hemorrhage into the adjacent pulmonary parenchyma [Figure 3a]. The tumor comprised sheets of loosely cohesive malignant tumor cells which had eccentric markedly pleomorphic nuclei, prominent nucleoli, vesicular with presence of fine strands of chromatin, and moderate amount of eosinophilic cytoplasm [Figure 3b]. The tumor cells were immunoreactive to vascular markers ERG and CD31 [Figure 3c and d], and are negative to CD34.