PMC6554484_01
A chest computed tomography scan revealed a solitary nodule accompanying a central radiolucency in the right lower lobe when the patient was 61 years old (A and B), which had apparently grown compared to its size when she was 54 years old (arrow mark) (C). A fluorodeoxyglucose (FDG)-positron emission tomography scan when her was 61 years old revealed a high maximum standardized uptake value of 5.2 on the solid portion of the tumor while a central portion showed negative FDG uptake (D).
gr1.jpg
PMC6554484_01_gr1.jpg
fig1
A contrast-enhanced chest CT scan revealed a solitary and well-circumscribed nodule (36 x 37 x 40 mm in diameter) in the peripheral region of the right lower lobe (Fig. 1A). While a solid part of the tumor was homogeneously enhanced, the tumor included an irregular-shaped low-density area (19 mm in maximum diameter) that was free from contrast-enhancement (Fig. 1B). Her medical record showed that a small lung nodule was previously recognized on a CT scan in our hospital when she was 54 years old (Fig. 1C). The initial CT scan when her was 54 years old showed a small nodule (7.5 x 7.9 x 8.7 mm in diameter) in the right lower lobe (Fig. 1C, an arrow mark), which corresponded with the grown tumor in the present study. FDG uptake (Fig. 1D). Following this, a diagnostic CT-guided transcutaneous core needle biopsy was scheduled.
A microscopic examination of the pathological specimen obtained by a transcutaneous core needle biopsy predominantly showed solid (A) and papillary (B) patterns, in concomitance with the minor findings of sclerosing (C) and hemorrhagic (D) components (hematoxylin and eosin staining).
gr2.jpg
PMC6554484_01_gr2.jpg
fig2
The biopsy specimen obtained from the solid part of the tumor was composed of two major pathological patterns, a solid proliferation of round cells and papillary growth of type II pneumocyte-like cuboidal cells overlying a core comprised of round cells (Fig. 2A and B). Sclerotic and hemorrhagic patterns were also evident in minor regions (Fig. 2C and D).
An examination of the gross features of the surgical specimen revealed an encapsulated tumor underneath the visceral pleura with intratumoral gross hematoma (A and B). A microscopic examination predominantly showed papillary growths of cuboidal and round cells on hematoxylin and eosin staining (C). The surface cuboidal cells stained positive for cytokeratin-7 (D), thyroid transcription factor-1 (TTF-1) (E), and napsin A (F), while the round cells were positive only for TTF-1 (Fig. 3E).
gr3.jpg
PMC6554484_01_gr3.jpg
fig3
Tachikawa Hospital. An examination of the gross features of the fixed lung revealed an encapsulated tumor (30 x 35 x 35 mm in size) underneath the visceral pleura in the right lower lobe accompanying a cavitary space filled with bloody content (Fig. 3A and B). The cavity formation was pathologically attributed to a gross hematoma but not to the hemorrhagic cyst nor to tumor necrosis. The microscopic examination of a solid part of the resected tumor confirmed a diagnosis of PSP, predominantly showing a papillary growth pattern with a portion of solid and sclerotic patterns (Fig. 3C). Immune-staining was positive for cytokeratin 7 (Fig. 3D), thyroid transcription factor-1 (TTF-1) (Fig. 3E), and napsin A (Fig. 3F) on the papillary-growing type II pneumocyte-like cuboidal cells whereas solid-growing round cells were positive only for TTF-1 (Fig. 3E). Together, the immune staining patterns were consistent with those related to PSP.