PMC5925118_01
CT scan showing mediastinal mass narrowing the right pulmonary artery with full occlusion of the left pulmonary artery.
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She was found to have an amorphous, invasive superior left mediastinal mass involving the main and left pulmonary arteries with occlusion of the left pulmonary arterial tree and severe narrowing of the right pulmonary artery (Figure 1).
Fluoroscopic view showing stenotic portion of the proximal right pulmonary artery prior to stenting.
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Her gradients improved immediately after stenting, and she tolerated the procedure without complication (Figures 2 and 3).
Fluoroscopic view of the right pulmonary artery showing stent across the previously stenotic area.
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Her gradients improved immediately after stenting, and she tolerated the procedure without complication (Figures 2 and 3).
Biopsy results. (a) Hematoxylin and eosin stain (H&E) at 2x magnification-fibrosis with chronic inflammatory cell response. (b) H&E at 20x magnification-macrophages with lymphocytes and plasma cells. (c) H&E at 40x magnification-emperipolesis. (d) CD163 immunostain at 20x magnification highlighting macrophages. (e) CD45 immunostain at 40x magnification highlighting lymphocytes and emperipolesis.
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A fourth biopsy taken at the time of stenting ultimately revealed fibrous tissue with lymphohistiocytic and plasma cell infiltrate with positive staining for S100, CD68, and CD163, negative staining for CD1a and Factor XIIIa, and emperipolesis, consistent with extranodal Rosai-Dorfman disease (Figure 4).