PMC4524584_01
CT scan appearance.. Notes: (A and B) Chest computed tomography on hospital admission showed irregular mass in the lingual segment of upper lobe of left lung (arrows). (C and D) Abdomen CT scan demonstrated multiple masses occupying gastrointestinal cavity, spleen, and left adrenal gland (arrows).. Abbreviation: CT, computed tomography.
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She was then followed with contrast computed tomography (CT), which revealed a 2.5x1.5 cm broad-based enhancement at the lingual segment of the left upper border, near the hilum, with hilar lymphadenopathy (Figure 1A and B). An abdominal contrast CT was then performed, which demonstrated multiple mass-like lesions occupying the gastrointestinal cavity, spleen, and left adrenal gland (Figure 1C and D).
Findings from endoscopy.. Notes: (A) Bronchoscopy demonstrated a tumor mass in the left lingual bronchus (arrow). (B) The tumor projected into the left main bronchus on the second admission (arrow). (C) Gastroscopy demonstrated multiple submucosal masses in the fundus of the stomach (arrows). (D) Multiple lesions were also seen in the duodenum (arrows).
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Electronic bronchoscopy was then done revealing a white polypoid tumor, which occupied the left lingular bronchus without any signs of invasion or protrusion into the left main bronchus (Figure 2A). We performed another bronchoscopy, which showed the same white polypoid tumor with significant protrusion into the left main bronchus (Figure 2B). An upper endoscopy was performed with ligation of mass lesions in the fundus, antrum, and duodenum (Figure 2C and D).
Microscopic appearances.. Notes: (A) Tumor cells of lung, adjacent to small vessels, were mostly oval to spindle with abundant pale cytoplasm and distinct cell borders and the tumor showed focal necrosis with inflammatory exudate (H&E stain, 200x). (B) The metastatic tumor in gastric antrum reveals similar morphology (H&E stain, 200x). (C) Marked nuclei and prominent nucleoli in present with mitotic activity (H&E stain, 400x). (D-F) Immunohistochemistry: tumor cells of lung showed strong immunoreactivity for smooth muscle actin and vimentin, and it was partially positive for CD99 (200x).. Abbreviation: H&E, hematoxylin and eosin.
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Immunohistochemistry of the biopsy specimens obtained via bronchoscopy stained positive for smooth muscle actin and vimentin, and was partially positive for CD99 (Figure 3) and F8.