PMC7436776_01
Lipoma on right chest wall.
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His past medical history was significant for poor baseline functional status, obesity hypoventilation syndrome, and obstructive sleep apnea on bilevel positive airway pressure ventilation nightly and with naps, chronic obstructive pulmonary disease on 4 L supplemental oxygen at home, chronic diastolic heart failure, paroxysmal atrial fibrillation, chronic kidney disease, history of pulmonary embolism, morbid obesity with a body mass index of 72 kg/m2, and a large right chest wall mass (Figure 1).
Ultrasound of the chest wall showing an echogenic lobulated soft tissue mass with extensive subcutaneous edema.
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An ultrasound of the chest wall revealed a nonspecific echogenic lobulated soft tissue mass with extensive subcutaneous edema and interdigitating hypoechoic septations in the right chest wall (Figure 2).
X-ray of the chest showing right hemithorax opacification (arrow).
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A repeat chest radiograph showed complete opacification of the right hemithorax with nonvisualization beyond the right main bronchus (Figure 3).
CT thorax showing a right chest wall mass (arrow) with diffuse edema and collapse of the right lung.
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Further investigation with a computed tomography (CT) scan (Figure 4) of the thorax, showed complete collapse of the right lung, extensive nonspecific soft tissue edema in the right anterolateral chest wall, right axilla, and right shoulder with a large right pleural effusion.
Biopsy sample with hematoxylin and eosin staining showing a fibrous (green arrow) and a lipomatous (red arrow) component.
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A core needle biopsy with histopathology of the soft tissue chest wall mass showed largely adipose tissue, a fragment of fibrous tissue, edematous changes, and focal chronic inflammation (Figures 5 and 6).
Biopsy sample under 10x magnification with hematoxylin and eosin staining showing adipose cells.
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A core needle biopsy with histopathology of the soft tissue chest wall mass showed largely adipose tissue, a fragment of fibrous tissue, edematous changes, and focal chronic inflammation (Figures 5 and 6).
Immunohistochemistry: from the left to the right: (1) CDK4, (2) MDM2, and (3) beta-catenin.
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Beta-catenin staining to rule out fibromatosis was absent in the fibrous component (Figure 7).