PMC8291962_01
Mediastinal windows of computed tomography (A and B) confirm the previously noted bilateral pleural thickening, calcification. There is associated left lobe Pleural effusion and atelectasis.
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Chest computed tomography (CT) showed diffuse thickening and calcification of the pleura on both sides, pleural effusion and atelectasis on the left side (Figure 1A and B).
Right lung branch pulmonary embolism, mainly involved pulmonary artery (arrow).
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Then, the computed tomography pulmonary angiography (CTPA) was performed for the patient, and the results showed that there was embolism in the right pulmonary artery branch (Figure 2).
Mediastinal windows of computed tomography (A and B) revealed pleural effusion on the left side.
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However, after being discharged from the hospital, the patient was still admitted to the hospital several times due to chest pain and dyspnea, and the reexamined chest CT still showed a large amount of pleural effusion on the left side (Figure 3A and B).
PET-CT suggests thickening and calcification of the pleura on both sides, increased FDG metabolism, more pronounced on the left.
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FDG metabolism was increased, and malignant tumors were considered (Figure 4).
Ultrasound guided biopsy specimen from tumor lesions. Fibroblast-like spindle cells arranged in bundles or chaotically, the tumor cells had obvious atypia, mitotic figures, and coagulative necrosis. ((A and B), hematoxylin-eosin).
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Later, the patient underwent an ultrasound-guided pleural biopsy, and the pathological examination revealed fibroblast-like spindle cells arranged in bundles or chaotic shapes (Figure 5A and B).
Immunohistochemical staining (20 X) revealed WT-1 positivity (A), GATA-3 positivity (B) and CK (pan) positivity (C).
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HMB45(Melanoma)(-), MyoD1(-), Caldesmon(-), D2-40(-), CEA(-), Vimentin(-) (Figure 6). Combined with the above examination results, the final diagnosis was sarcomatoid pleural mesothelioma. However, two days later, the patient suddenly developed a coma, facial cyanosis, and sudden cardiac arrest.