PMC5078677_01
Chest radiograph shows consolidative mass in the right mediastinal area (arrow) and left pleural effusion.
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Chest radiograph showed consolidation in the right paratracheal area that suggestive of central malignancy (Fig. 1).
Chest computed tomography (CT) scan shows 38 mm primary lung mass invading the right mediastinum (arrow) (A). On coronal image, SVC mass is extended to the right atrium (B). Transverse lung window CT image shows the mass fully occupying the SVC (C). PET-CT images shows FDG uptake with SUVmax of 10.6 on the SVC mass (D).
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The CT revealed a soft-tissue mass in the right paratracheal area that has invaded into the SVC and extended to the right atrium with bilateral pleural effusions (Fig. 2A-C). Positron emission tomography (PET)-CT with 18F-fluorodeoxyglucose (FDG) showed increased FDG uptake, with a maximum standardized uptake value (SUVmax) of 10.6 in the SVC (Fig. 2D).
Endobronchial ultrasound imaging and pathology specimens from EBUS-TBNA. Ultrasound imaging shows the mass within SVC wall (arrows) (A). The biopsy shows poorly differentiated adenocarcinoma (H&E, x400) (B).
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The tumor was punctured using a 22-gauge needle under real-time visualization (Fig. 3A). TTF-1-positive immunohistochemistry (Fig. 3B). There were no epidermal growth factor receptor (EGFR) gene mutations or KRAS gene mutations.
Initial lung mass in chest CT scan (A), and follow up chest CT shows interval decrease in size of the primary lung cancer (B).
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Two months after the chemotherapy, chest CT showed that the tumor size was decreased and his symptoms were relieved as well (Fig. 4).