PMC10126498_01
Continuous coronal computed tomography (CT) images. A mass with a high-density shadow was observed in the left thoracic cavity, with an irregular boundary and adjacent pleural thickening and adhesion. We intercepted a section of the continuous CT images from the appearance of the spinal canal to the disappearance of the tumor (A-F), all of which showed no involvement of the spinal canal by the tumor.
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Chest computed tomography (CT) ( Figure 1 ) revealed the presence of a large mass in the left thorax.
Gross pathological examination. Thoracic cavity: a grayish-white solid mass with indistinct borders (A). The mass was 9.5 cm x 8.4 cm x 5.3 cm in size. Bleeding and calcification were visible in the transverse section (B).
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Postoperative gross findings ( Figure 2 ) indicated that the lesion was a grayish-white solid mass with indistinct borders.
Morphology. (A) Scanning power showing normal alveolar structure in the upper left corner, and the tumor (underneath) is clearly separated from the lung tissue via pleural thickening. (B) A dilated hemorrhagic focus around the tumor, similar to cavernous hemangioma or hemangiopericytoma. (C) In the dense area of the tumor cells, the cells are round or irregular in shape, with less cytoplasm, uniform nuclear chromatin, and visible nucleoli and mitoses (2/10 HPF). (D) In the sparse area of the tumor cells, the cells are arranged in a fascicular, whorled, storiform and meningithelial pattern, with unclear borders between cells. These cells do not exhibit any obvious atypia, with fine chromatin, inconspicuous nucleoli, and rare mitotic figures. (E) Interstitial hyaline degeneration. (F) Presence of many psammoma bodies.
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The boundary of the mass was blurred at low magnification and involved the lung surface pleura ( Figure 3A ); however, the alveolar structures were normal, and the histomorphology of the mass was distinct from that of alveolar structures. The lesion was surrounded by dilated hemorrhagic areas resembling cavernous hemangioma or hemangiopericytoma ( Figure 3B ). In the dense area of the tumor cells, the cells were round or irregular in shape, with less cytoplasm, uniform nuclear chromatin, and visible nucleoli and mitoses (2/10 HPF) ( Figure 3C ). In the sparse area of the tumor cells, the cells were arranged in a fascicular, whorled, storiform and meningithelial pattern ( Figure 3D ), with occasional intranuclear pseudo-inclusions or interstitial hyaline degeneration ( Figure 3E ). Lots of psammoma bodies were observed in the tumor tissue ( Figure 3F ), but no obvious inflammatory infiltration or necrosis were observed.
Immunohistochemistry. The tumor is diffusely and strongly positive for EMA (A), scanning power is displayed in the lower right corner), vimentin (B) and SSTR2 (C). The tumor is diffusely and weakly positive for PR (D). The tumor is focally and weakly positive for S100 protein (E). The tumor is negative for GFAP (F), SOX-10 (G), inhibin, CD34, STAT6, SMA, desmin, CKpan, D2-40, WT-1, CK5/6 and CD45. The highest proliferation index by Ki-67 is 15% (H), and the tumor cells express cytoplasmic ALK (I).
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