PMC6595336_01
(a) and (b): pre- and postcontrast MRI demonstrating large right frontal ring-enhancing mass, October 2008. (c) Chest CT with mass in the left lung, May 2009.
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Subsequently a pre- and postcontrast magnetic resonance imaging (MRI) was performed that showed a right frontal mass [Figures 1(a) and 1(b)]. Six months later, chest imaging performed in preparation for insertion of a central catheter showed a left upper lobe lung lesion which was suspicious for malignancy [Figure 1(c)].
Brain tumor. (a) The tumor is composed of large and small cells (LFB/H&E, 100x). (b) The tumor contains many multinucleated giant cells (LFB/H&E, 400x). (c) The tumor displaying necrosis with palisade (H&E, 100x).
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Histologically, the initial resection specimen of the right frontal lobe mass was a high-grade glioma that infiltrated the adjacent brain tissue [Figure 2]. The tumor was composed of a mixture of small to medium sized cells and some very large, often multinucleated, giant cells [Figures 2(a)-2(c)].
Lung tumor. (a) The tumor forms a solid mass (left side) with bordering alveoli (right side) (H&E, 100x). (b) Necrosis in the lung tumor (H&E, 100x). (c) GFAP immunostain demonstrating immunopositive tumor cells in the lung with immunonegative pulmonary cells (right side) (GFAP immunostain, 100x).
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The left lower lobe lung tumor was a metastatic glioma characterized by nests and sheets of cells with moderate to abundant amounts of eosinophilic to pale cytoplasm [Figure 3(a)]. Mitotic figures were easily identifiable, and there were areas of necrosis [Figure 3(b)]. Immunostains revealed tumor cells with cytoplasmic immunoreactivity for vimentin, GFAP [Figure 3(c)], and S100 protein along with rare cells immunopositive for epithelial membrane antigen (EMA).