PMC10244673_01
CT and MRI scan results for the patient (A) CT: Soft tissue nodular mass in the left upper lung adjacent to the mediastinum, measuring approximately 1.31x1.79 cm; multiple masses and enlarged lymph nodes in the aortopulmonary window, above the eminence, and both lung hilums; larger mass at the left lung hilum measuring 1.29x2.06 cm; (3) Mass with slight density visible in the left axilla, unevenly enhanced nodule is visible, measuring approximately 2.32x2.5 cm. (B) MRI: Dynamic contrast-enhanced MRI: multiple masses and enlarged lymph nodes in the aortopulmonary window, above the eminence, and both lung hilums; mass in the left lung hilum measuring approximately 1.6x1.6 cm; Enlarged lymph nodes visible in the left axilla, measuring approximately 2.4x1.9 cm.
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A chest CT and MRI showed a left upper lung mass indicative of a malignant lesion ( Figures 1A, B ).
Pathological examination results for the patient (A) The fibrous border of the tumor (HE 20x) (B) Tumor cells were glandular in shape, with a nest-like adenoid structure (HE 200x) (C) Necrosis and phagocytosis were seen in the central part of the glandular lumen in some area (HE 200x) (D) Some cells were polygonal, with eosinophilic or clear cytoplasm (HE 200x) (E) Sieve-like structures were observed. Some of the cytoplasm and the central part of the glandular lumen had neutral mucus (HE 200x) (F) Abundant cytoplasm, biphasic, with distinct vesicular nuclei, small nucleoli, and apoptotic vesicles were visible (HE 200x) (G) Enlarged nucleoli and high nuclear grade were seen in some of the vesicular nuclei (HE 200x) (H) Some of the vesicular nuclei were enlarged and had high nuclear grade, with fine, open chromatin in the nuclei and pathological nuclear divisions (HE 400x) (I) The cancerous tissue directly invaded the hilar lymph nodes (HE 20x).
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A lung puncture biopsy was performed, and metastatic adenocarcinoma was considered ( Figure 2 ).