PMC10102462_01
Chest computed tomography (CT) images (A-F). (A) Irregular soft tissue density mass in the upper left thorax. (B) The mediastinal window shows a lamellar hypodense shadow within the mass (arrow). (C) The bone window shows bone destruction of the left first rib and visible periosteal new bone formation (arrow). (D) Mild to moderate heterogeneous enhancement of the lesion with non-enhancing hypodense areas within it (arrow). (E) Persistent enhancement of the lesion in the venous phase. (F) The sagittal section shows bone destruction of the left first rib (yellow arrow) and lamellar hypodense areas within the mass (red arrow).
fonc-13-1137586-g001.jpg
PMC10102462_01_fonc-13-1137586-g001.jpg
f1
Its wide base was connected to the adjacent pleura ( Figure 1 ).
Magnetic resonance imaging (MRI) of the thorax (A-G). (A, B) An irregular soft tissue mass is seen in the upper part of the left thorax, showing a mixed signal dominated by iso-T1 and iso-T2 signals. (C) T2WI lipid suppression shows a heterogeneous slightly high signal; few long T2 signals are seen within the mass (arrow). (D) The solid part of the mass shows a distinct high signal on DWI. (E) This corresponds to a low signal on the ADC map. (F) The solid part of the lesion is heterogeneously enhanced; no enhancement is seen in the internal liquefied necrotic area (arrow). (G) The enhanced sagittal view reveals a bony destruction of the left first rib (blue arrow) and a lamellar area of non-enhancement within the mass (white arrow).
fonc-13-1137586-g002.jpg
PMC10102462_01_fonc-13-1137586-g002.jpg
f2
T2 lipid suppression; a few liquefied necrotic areas within the mass, showing slightly long T1 and T2 signals; a significantly high signal in the solid part of the mass on diffusion weight images (DWI), corresponding to a low signal on apparent diffusion coefficient (ADC) maps; and distended bone destruction in the adjacent left first rib ( Figure 2 ). The technetium-99m methylene diphosphonate bone scan showed an abnormal focus of intense tracer accumulation in the left first rib.
Immunohistochemistry. (A) Hematoxylin and eosin (HE) staining (x200); (B) HE staining (x400); (C) CD99 (++++) (x200); (D) CD99 (++++) (x400); (E) NKX2.2 (++++) (x200); (F) NKX2.2 (++++) (x400).
fonc-13-1137586-g003.jpg
PMC10102462_01_fonc-13-1137586-g003.jpg
f3
Timeline.
fonc-13-1137586-g004.jpg
PMC10102462_01_fonc-13-1137586-g004.jpg
f4
Therefore, to inhibit tumor growth, systemic chemotherapy with alternating programs of vincristine, doxorubicin, and cyclophosphamide (VDC) and isocyclophosphamide and etoposide (IE) was given at 3-week intervals ( Figure 4 ).