PMC4681984_01
Chest X-ray depicting a left pleural effusion.
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A chest X-ray (Fig. 1) revealed a large left pleural effusion.
CT scan depicting a large left pulmonary mass infiltrating the left pulmonary artery, left main bronchus and main carina as well as a severe pericardial effusion that is primarily localized around the left ventricle. An enlarged subcarinal lymph node is also visible.
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A computed tomography (CT) scan (Fig. 2) revealed a large left pulmonary mass that infiltrated the left pulmonary artery, left main bronchus and main carina as well as a severe pericardial effusion that was primarily localized around the left ventricle.
Bronchoscopy revealed a whitish exophytic lesion that almost completely obstructs the left main bronchus.
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A bronchoscopy (Fig. 3) revealed a whitish exophytic lesion that almost completely obstructed the left main bronchus.
Autopsy revealed a tumor mass with large dimensions that weighed 1750 g. The tumor occupied the entire left hemithorax; surrounded and infiltrated the left main bronchus and left great vessels; and was firmly adhered to the chest wall, diaphragm, pericardium and left atrium wall.
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At the macroscopic level (Fig. 4), the autopsy revealed a tumor mass with large dimensions that weighed 1750 g.
(A,B) The biopsy revealed a cellular tumor comprising of nests and groups of polygonal to spindle shaped pleomorphic cells, separated by fibrous septa, having high nuclear to cytoplasmic ratio, high mitosis and some areas of necrosis.
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Microscopically (Fig. 5), an intense infiltrate of undifferentiated tumor cells with extensive mitosis was observed.
Immunohistochemistry indicated that tumor cells were positive for CK7 (A), 34B12 (B), desmin (C) and vimentin (D), confirming the diagnosis of desmoplastic small round cell tumor.
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Immunohistochemical assessments indicated that tumor cells were negative for leukocyte common antigen (LCA), cytokeratin, neuron-specific enolase, synaptophysin, smooth muscle actin (SMA), CD1, S-100, CD15, chromogranin, CD57 and CD99 but strongly expressed CK7, 34B12, desmin and vimentin (Fig. 6).