PMC6104199_01
Posteroantenor chest radiographs of patient. (a) On admission. (b) After six cycles of chemotherapy.
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Posteroanterior chest radiography revealed a homogeneous density that blunted the left costophrenic and cardiophrenic sinuses, along with the formation of Damoiseau's line, which suggested pleural effusion (Fig. 1a). After establishing a diagnosis, the patient received systemic chemotherapy consisting of Cisplatin (75 mg/m2, day 1) and Docetaxel (75 mg/m2, day 1) once every three weeks for six cycles and showed a nearly complete response (Fig. 1b).
Thorax CT showing pleural fluid accumulation and pleural thickening areas, accompanied by pleural nodules in the left hemithorax.
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The largest of these pleural nodules was found to be 2x1 cm in size and involved an invasion of the third rib from the posterolateral area (Fig. 2).
PET-CT demonstrating intense 18-FDG uptake by several thickened mediastinal and costal pleural areas, without the presence of a salient primary lesion in the lung parenchyma.
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In addition, PET-CT showed the destruction of the posterolateral area of the third rib secondary to tumoral invasion (Fig. 3).
Pathological view of the tumor cells. (a) Hematoxylin and eosin staining showing island formation of tumor cells in the inflammatory stroma. (b) Nuclear staining with p63 antibodies (100x). (c) No staining with vimentin antibodies (100x).
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In addition, the tumor cells could not be stained with vimentin or calretinin stains (Fig. 4).
Brain magnetic resonance imaging revealing a metastatic lesion in the left frontoparietal lobe and peritumoral edema in the left frontopariteal and right parietal lobes.
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Three weeks later, new brain metastases were determined, which caused sudden difficulties in speech (Fig. 5).