PMC3821793_01
(A) Baseline computed tomography (CT) scan of the chest with contrast on initial evaluation. (B) Follow-up CT scan at 1 month after radiotherapy. (C) A CT scan taken 2 months after chemotherapy indicating stable disease. (D) A CT scan taken 60 days later showing dramatic improvement in the mediastinal tumor after treatment with oral sorafenib 400 mg twice per day.
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A computed tomography (CT) scan showed an anterior mediastinal mass (87.1 x 75.0 mm, Figure 1A), accompanied by multiple mediastinal lymph-node metastases, hydropericardium, and lumbar vertebrae metastases. A month later, a chest CT scan showed that the size of the mass had shrunk to 60.5 x 47.6 mm (Figure 1B). Two months after chemotherapy, a CT scan indicated stable disease, with a mass size of 54.6 x 40.4 mm (Figure 1C). After 60 days, there was a dramatic improvement in the mediastinal tumor: the mass size decreased to 43.5 x 27.1 mm (Figure 1D).
Hematoxylin and eosin staining of the biopsied specimen. Groups of cells have a characteristic Zellballen nested appearance. The groups of cells were composed of polyhedral cells with granular amphophilic cytoplasm.
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The examination further revealed groups of cells with characteristic Zellballen nested appearance (Figure 2).
(A-D) Immunohistochemical staining of the biopsied specimen. Immunohistochemical staining was positive for Ki-67 (A), CD56 (B), chromogranin A (C), and synaptophysin (D), demonstrating sustentacular cells around the periphery of the cell nests and supporting the diagnosis of paraganglioma (immunohistochemistry, EnVision).
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On the basis of the histologic and immunohistochemical features, a diagnosis of paraganglioma was proposed (Figure 3).