PMC6205929_01
On admission, chest x-ray showed a large left sided pleural effusion.
gr1.jpg
PMC6205929_01_gr1.jpg
fig1
Chest x-ray revealed a large left-sided pleural effusion (Fig. 1).
Approximately 700 ml of milky colored fluid was obtained on thoracentesis.
gr2.jpg
PMC6205929_01_gr2.jpg
fig2
He was admitted to the hospital for further evaluation and underwent both a diagnostic and therapeutic thoracentesis (Fig. 2).
The patient's pleural fluid cytology specimen showing (A) non-clustered, bland appearing mesothelial cells on Diff Quik stain, 600X (B) non-clustered, bland appearing mesothelial cells on Papanicolaou stain, 600X (C) positive calretinin IHC stain highlighting and supporting mesothelial origin, 400X, and (D) negative MOC-31 IHC stain, 400X ruling out carcinoma and lending further supporting to the mesothelial origin.
gr3.jpg
PMC6205929_01_gr3.jpg
fig3
Adenocarcinoma was ruled out by negative BerEP4 and MOC-31 IHC stains (Fig. 3).
On admission, computed tomography of the chest showed (A) left lung infiltrate, and (B) pleural calcifications and mediastinal adenopathy. Lung window settings: thickness 1mm, width 1600.
gr4.jpg
PMC6205929_01_gr4.jpg
fig4
Computed tomography (CT) of the chest after the thoracentesis was performed revealing left lung airspace disease, pleural calcifications and mediastinal adenopathy (Fig. 4).
Computed tomography of the chest 3 months after initial admission showed worsening left lung infiltrate and a new right sided pleural effusion. Lung window settings: thickness 1mm, width 1600.
gr5.jpg
PMC6205929_01_gr5.jpg
fig5
CT chest revealed progression of the left lung infiltrate, a new right-sided pleural effusion and persistent mediastinal adenopathy (Fig. 5).
Autopsy specimen images showing abundant non-clustered, bland-appearing epithelioid mesothelial cells replacing the lymph node (A- low magnification, 40X & B- high magnification, 100X) and (C) invading connective tissue on Hematoxylin & Eosin stain, 100X.
gr6.jpg
PMC6205929_01_gr6.jpg
fig6
Furthermore, metastatic tumor cells were evident in multiple mediastinal lymph nodes (Fig. 6).