PMC2851579_01
A CT scan with contrast of the chest showing large left upper lobe lung mass involving the pleural surface.
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F1
Due to his chest symptoms, he had a chest x-ray followed by Computerized Tomography (CT) scan of the chest which showed a left upper lung mass (4.5 x 5.5 x 5 cm) with mediastinal and right hilar adenopathy [Fig.1].
A GMS stain showing aspergillus fungal hyphae with uniform septated hyphae, and branching at 45 degrees (x100, Gomori Methanamine Silver stain).
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F2
On Gomori Methanamine Silver (GMS) stain, the hyphae had uniform diameter, septation and branching at 45 degree, morphologically compatible with aspergillus species [Fig. 2].
Carcinosarcoma with areas of sarcomatous spindle cell proliferation (left) and an epithelial carcinoma component (right). (x100, Hematoxylin and Eosin).
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F3
Interestingly, final surgical pathology examination revealed a poorly differentiated biphasic malignant neoplasm with epithelial and spindle cell components and necrosis [Fig. 3].
Epithelial carcinoma component of the tumor positive for cytokeratin AE1/AE3 immunostain (x100).
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F4
The epithelial carcinomatous tumor cells showed strong immunoreactivity with pankeratin AE1/AE3 (Fig. 4) and epithelial membrane antigen (EMA) (Fig. 5) and focally for
Sarcoma component of the tumor showing spindle tumor cells positive for vimentin (x400).
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F6
P63; while vimentin stain was strongly positive in the spindle cell component but not in the carcinomatous component [Fig. 6]. Patchy foci of spindle tumor cells were reactive for calponin and smooth muscle actin.
An area of the tumor showing hemorrhagic infarction and shadow outlines of destructed blood vessels (x100, Hematoxylin and Eosin).
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F7
Within the resection specimen areas of infarction and coagulative necrosis were identified, some of them bordering viable tumor (Fig. 7).
Groups of aspergillus fungal hyphae are present in an area of hemorrhagic infarction in the resected specimen (x400, Gomori Methanamine Silver stain).
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F8
In one such area, fungal hyphae morphologically consistent with aspergillus species were seen and confirmed by GMS fungal stain (Fig. 8).