PMC5505912_01
Chest X-ray showed a mass shadow in the peripheral area of the left upper zone, and widespread diffuse reticular shadows.
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Chest X-ray showed a mass shadow in the peripheral area of the left upper zone (Fig. 1).
A computed tomography (CT) scan of the chest revealed a mass in the left upper lobe (S3; 4.1x6.4x4.5 cm) with features suggestive of pleural infiltration, and marked enlargement of the left hilar, superior mediastinal, para-aortic, and axillary lymph nodes. There was a separate left para-spinal mass (4.3x3.0 cm) progressing into the vertebral canal at the Th5 vertebral level. There were also upper lobe dominant cystic spaces.
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There were upper-lobe dominant cystic spaces that were considered to be pathologically correlated with progressive-stage interstitial lung disease (ILD) (Fig. 2).
PET-CT revealed high accumulation in the left upper lobe mass (standardized uptake value max: SUVmax 9.5) (Fig. 3), the left para-spinal mass (SUVmax 10.4), enlarged lymph nodes, and the left femoral head (SUVmax 8.0)
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Positron emission tomography (PET)-CT revealed high accumulation in the left upper lobe mass, the left paraspinal mass, the enlarged lymph nodes, and the left femoral head (Fig. 3).
A transbronchial biopsy of the left upper lobe mass revealed small-sized tumor cells possessing minimal cytoplasm and hyperchromatic indistinct nucleoli with abnormal mitosis. (Original Magnification)
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A transbronchial lung biopsy of the left upper lobe mass revealed small cell carcinoma with neuroendocrine characteristics (Fig. 4, 5).
Immunohistochemical staining revealed that the tumor cells were positive for chromogranin A, synaptophysin, and thyroid transcription factor-1 (TTF-1), and negative for p40. Ki-67 antigen (MIB-1) labeling index was 96%.
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A transbronchial lung biopsy of the left upper lobe mass revealed small cell carcinoma with neuroendocrine characteristics (Fig. 4, 5).