PMC5521335_01
PET-CT scan after chemotherapy and before surgical exploration.
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Additionally, there was close proximity of the tumor to the aortic arch, but vessel wall invasion was not evident according to the radiology report (Figure 1).
CTA revealing the presence of infrarenal aortic occlusion and coexistence of atherosclerotic lesions in iliac arteries.
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The patient immediately underwent a CT angiography that revealed thrombosis of the infrarenal aorta in the presence of atherosclerotic lesions of the iliac arteries bilaterally (Figure 2).
(a-c) Fine needle biopsy of the primary lung tumor shows moderately differentiated lung adenocarcinoma: (a) hematoxylin and eosin stain x200, (b) TTF-1 positivity x200 and (c) CK7 positivity x200. (d-f) Carcinomatous invasion of the aortic wall: (d and e) hematoxylin and eosin stain x20 and x40, respectively, and (f) TTF-1 positivity x100. (g-i) Tumoral embolus material that shows tumor aggregates in between fibrin and erythrocytes: (g) hematoxylin and eosin stain x40, (h) hematoxylin and eosin stain x100 and (i) Alcian blue stain demonstrates mucin production by the neoplastic cells, x400.
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Histopathological characteristics of thrombus obtained during embolectomy (Figure 3(g)-(i)) were consistent with the histopathology of the biopsy of the primary lung tumor (Figure 3(a)-(c)). The histopathology of the fraction of tumor adjacent to aortic arch revealed invasion of aortic adventitia (Figure 3(d)-(f)).