PMC9429989_01
PMC9429989_02
specimen from bronchoscopic biopsy showing numerous hyphae with septation consistent with aspergillosis (arrows)
PAMJ-42-135-g001.jpg
PMC9429989_02_PAMJ-42-135-g001.jpg
F1
A culture of bronchoalveolar lavage fluid confirmed the presence of Aspergillus fumigatus (Figure 1).
chest computerized tomography scan showing: A) large lung soft tissue mass lesion with areas of necrosis (red dashed line); B) left inferior pulmonary vein and left atrium thrombosis (green dashed line)
PAMJ-42-135-g002.jpg
PMC9429989_02_PAMJ-42-135-g002.jpg
F2
Caspofungin administration, she presented with worsening symptoms and was admitted for further evaluation. Chest computed tomography (CT) scan showed an 8 x 4 cm heterogeneous, well-defined left lower lobe mass with areas of soft tissue enhancement and necrosis, invasion of the left atrium, the left main bronchus, and left pulmonary artery, and compression of the left inferior pulmonary vein (Figure 2).
pathologic examination showing: A) proliferating spindle cells forming interlacing bundles and high mitotic figures (HE stain x 200); B) proliferating spindle cells forming interlacing bundles and high mitotic figures (HE stain x 400); C) immunohistochemistry stain showing diffuse positivity of vimentin; D) immunohistochemistry stain showing positive smooth muscle actin
PAMJ-42-135-g003.jpg
PMC9429989_02_PAMJ-42-135-g003.jpg
F3
The tumor was negative for CKAE1/AE3, Ck7, CK5/6, EMA, Calretinin, S100, P63, CD34, BCl2, Desmin, Myogenin, and CD117 immunostains ruling out other possibilities and confirming the diagnosis of leiomyosarcoma (Figure 3).
bone scan in anterior view (A), posterior view (B), and chest oblique views (C,D) showing multiple hot spots in the inferior angle of the scapula, 10th left rib posteriorly, and the vertebral discs suggestive of metastasis (stars)
PAMJ-42-135-g004.jpg
PMC9429989_02_PAMJ-42-135-g004.jpg
F4
functional single-photon emission computed tomography images in axial view (A), coronal view (B), and sagittal view (C) showing the increased area of activity in the inferior angle of the scapula, 10th left rib posteriorly, and the vertebral discs suggestive of metastasis (arrows)
PAMJ-42-135-g005.jpg
PMC9429989_02_PAMJ-42-135-g005.jpg
F5
Figure 5). Further, imaging with an abdominal CT scan with intravenous injection revealed multiple small liver lesions suggestive of metastasis (Figure 6).
abdominal computerized tomography scan showing hepatic hypodense lesions (arrow)
PAMJ-42-135-g006.jpg
PMC9429989_02_PAMJ-42-135-g006.jpg
F6
Figure 5). Further, imaging with an abdominal CT scan with intravenous injection revealed multiple small liver lesions suggestive of metastasis (Figure 6).