PMC5611870_01
Chest X-ray (Posteroanterior view) showing bilateral pleural effusions with an expansile lucent lesions with septations in the right fourth and fifth ribs (arrow).
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It also showed expansile lucent lesions with septations in the right fourth and fifth ribs (Figure 1).
Cystic lesion in the mediastinum on (a) noncontrast CT lung window and (b) noncontrast CT of the chest.
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The computed tomography (CT) scan revealed a large loculated pleural effusion with loculated fluid in the anterior mediastinum, a 3 cm mass in the right cardiophrenic angle, a 3 mm right lower lobe lung nodule, and two hypoenhancing lesions in the right hepatic lobe which were too small to be characterized (Figures 2(a) and 2(b)).
CT imaging of the pelvis showing cystic osteolytic (exceptional) bony lesion with a sclerotic rim within the (a) right acetabulum and (b) right iliac crest with FNAC needle.
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The X-ray of the femur revealed multiple lesions involving the right femur and right iliac bone with endosteal scalloping, lytic and moth eaten lesions suspicious for metastatic disease (Figure 3(a)). A second biopsy was taken from the iliac bone by interventional radiologist (IR) which only showed atypical cells and was nondiagnostic (Figure 3(b)).
Sagittal CT of cervical spine image showing expansile lesion at C3 with preserved surrounding cortex.
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A CT scan of cervical spine was also obtained which showed multiple expansile lesions throughout the cervical and thoracic spine which were most pronounced at C3, producing mild right paratracheal canal stenosis and severe right neuroforaminal stenosis at C3 and C4 (Figure 4).
(a) Histological section showing multiple dilated vascular channels of irregular sizes with flat endothelial cells; (b) anterior mediastinal biopsy showing findings suggestive of a cyst wall; (c) immunohistochemistry stain for D2-40 highlighting lymphovascular endothelium.
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It revealed multiple dilated vascular channels with flat endothelial like cells in the bone biopsies and mediastinal lesion with predominantly lymphangiomatous process (Figures 5(a) and 5(b)). On immunohistochemistry (IHC), these cells were focally positive for CD31 and D2-40 which suggested their origin from lymphovascular endothelium (Figure 5(c)).