PMC5366798_01
Computed tomography angiography of the thorax showing well-circumscribed, ovoid "cannonball" costophrenic mass in right lower lung lobe, consistent with appearance of metastasis.
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A computed tomography angiography (Figure 1) found no PE but revealed an ovoid 3.2 x 2.2 cm costophrenic angle mass of the right lower lung lobe with no evidence of hilar or mediastinal lymphadenopathy.
PET scan identifies costophrenic lung mass as peripherally hypermetabolic with relatively ametabolic central region, likely cavitation from necrosis (max SUV 3.9).
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Given the question of metastasis, a staging positron emission tomography (PET) scan was performed, revealing hypermetabolic foci in addition to the known lung mass with a max standardized uptake value (SUV) of 3.9 (Figure 2).
PET scan identifies intensely hypermetabolic nodular lesion on the left lateral chest wall inferior to left axilla, highly suspicious for malignancy (max SUV 12.5).
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PET scan identifies intensely hypermetabolic cutaneous lesion of the back. This patient has a history of multiple hypermetabolic cutaneous lesions with excisions.
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Normal lung tissue with intact alveolar spaces adjacent to the keratinizing squamous cell carcinoma, which, here, is more moderately differentiated and more clearly characteristic of SCC. The tumor measures 4.5 x 3.7 x 2.2 cm, and the distal border of the tumor invades the pleura.
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The lung SCC (Figures 5-7) is histopathologically similar to biopsies of prior cutaneous SCC (Figures 8 and 9).
SCC invasion of bronchus. Note the intact pseudostratified ciliated columnar epithelium of the bronchial wall to the left and upper right of the image, while the lower right portion shows the tumor breaking through the bronchial wall and invading the bronchial lumen.
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The lung SCC (Figures 5-7) is histopathologically similar to biopsies of prior cutaneous SCC (Figures 8 and 9).
Angioinvasion:SCC has engulfed all muscles layers of a large blood vessel wall. Only the endothelium of the tunica intima remains intact.
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The lung SCC (Figures 5-7) is histopathologically similar to biopsies of prior cutaneous SCC (Figures 8 and 9).
Left chest invasive cutaneous SCC measuring 9.8 cm, excised a few years ago, revealing desmoplastic reaction and deep invasion into subcutaneous fat, a strong predictor of metastasis. Moderately differentiated.
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The lung SCC (Figures 5-7) is histopathologically similar to biopsies of prior cutaneous SCC (Figures 8 and 9).
Right shoulder invasive cutaneous SCC measuring 7.8 cm, excised a few years ago, showing "nests" of deep dermal and subcutaneous invasion.
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The lung SCC (Figures 5-7) is histopathologically similar to biopsies of prior cutaneous SCC (Figures 8 and 9).
Left chest wall lymph node measuring 3.0 x 2.5 x 1.7 cm poorly differentiated, higher grade squamous cell carcinoma. Extranodal invasion is suspected but not definitive.
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Pathologic examination of the nodule did show it to be of histologically higher grade than the lung or skin SCC (Figure 10).