PMC6545337_01
Radiological examination. A: Plain chest X-ray film. 22 x 17mm tumor with unclear margin was observed in the upper lung field. B and C: Computed tomography of the chest in Axial and Sagittal slices. Tumor was disc-like shape spreading along the airways. D: PET-CT showed high SUVmax for the tumor and no metastasis was observed in the lymph nodes and other organs.
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Plain chest XP showed hazy nodular opacity in the right lung field with ill-defined margin (Fig. 1A). Chest CT showed that the tumor was disk like-shape in the posterior segment of right upper lobe (Fig. 1B and C). PET-CT showed strong positivity (SUVmax of 10) in the tumor (Fig. 1D) without metastasis to the lymph nodes, pleura and the other organs.
Histological examination. A: Macroscopic view of excised surgical specimen. The tumor was irregularly developed around the airway. A part of the tumor consisted with small nodules. B: Histology of the tumor with HE staining. Densely populated pleomorphic spindle cells were observed. The spindle cells were eosinophilic and arranged in interweaving bundles. Pleomorphic elongated nucleus strongly stained with Hematoxylin and nuclear divisions were observed (arrow head).
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Fig. 2A shows the macroscopic view of the tumor. Microscopic examination showed that the tumor was filled with dense spindle cells with pleomorphism and division of chromosome (Fig. 2B).
HE and Immunohistochemical stainings. A: Histology with HE staining. C, E and V stand for bronchial cartilage, epithelium and vessel. The thin arrow shows the normal structure of bronchial smooth muscle bundle. The thick arrow shows the transient area of normal structure of bronchial smooth muscle to leiomyosarcoma. B: Immunohistochemical staining for H-Caldesmon. Normal bronchial smooth muscle (thin arrow) and leiomyosarcoma (thick arrow) were stained. In the area of leiomyosarcoma, staining was denser than normal muscle bundle area showing dense population of malignant cells. Smooth muscle within the vessel was also normally stained (arrow head).
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The clear transition from normal smooth muscle bundle (Fig. 3A, thin arrow) to a cluster of malignant spindle cells was observed (Fig. 3A, thick arrow). Fig. 3B shows positive staining of H-Caldesmon for sarcoma cells as well as normal bronchial smooth muscle. Structure of the vessels in the tumor was preserved and smooth muscle cells of the vessels were normally stained (Fig. 3B, arrow heads).