PMC6010632_01
A: CT chest with PE protocol showing a non-calcified 14 mm pulmonary nodule in left lower lobe. B: CT chest with PE protocol showing a non-calcified 10mm pulmonary nodule in Right Middle Lobe. C: CT chest with PE protocol showing small non-calcified pulmonary nodules in Right and Left Upper Lobes.
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No pulmonary embolism was seen (Fig. 1A-C).
A: PET/CT scan showing mild FDG uptake in the Left Lower Lobe Nodule. B: PET/CT scan showing mild FDG uptake in the Right Middle Lobe Nodule.
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It again showed the largest nodule measuring 13 x 14 mm in the LLL, and a middle lobe nodule measuring 10 x 10 mm, both demonstrating mild FDG uptake (Fig. 2A and B).
CT chests with PE protocol comparing Right Middle Lobe nodule over 4 years.
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When compared with a CT performed four years prior, the LLL nodule was new and the middle lobe nodule had increased in size since that time (Fig. 3).
A: Low power view of the lung wedge resection specimen showing a well-circumscribed nodule composed of cytologically bland appearing spindle cells arranged in a fascicular pattern. B: Medium power view of the lung wedge resection specimen showing the fascicular pattern of the nodule with entrapped benign bronchiolar epithelium (epithelial entrapment rather than obliteration being a reflection of indolent rather than aggressive growth of the neoplasm). C: High power view of the lung wedge resection specimen showing the cytologically bland appearance of the spindle cells (lack of any significant nuclear atypia); also, inconspicuous mitoses (no significant mitotic activity), and no necrosis. D: Core biopsy, desmin immunostain (marker of smooth muscle and skeletal muscle differentiation), showing strong and diffuse expression in the neoplastic cells. The appearance of the smooth muscle actin (SMA) immunostain, which was also done on the core, is identical. E: Core biopsy, progesterone receptor immunostain, showing strong and diffuse nuclear expression in the neoplastic cells. The estrogen receptor immunostain showed similar results. F: Wedge resection specimen, DOG-1 immunostain, showing unexpected diffuse expression in the neoplastic cells. The CD117 (c-kit) immunostain was negative. The DOG-1 is typically positive for GIST, but has also been reported to show expression in some uterine type retroperitoneal leiomyomas and peritoneal leiomyomatosis.
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However, this result has also been reported for uterine type retroperitoneal leiomyomas and peritoneal leiomyomatosis (Fig. 4A-F).
Karyotype showing 41,X,-X,add(1) (p13),add(2) (p1?6),del(4) (q12q21),add(7) (q22),-14,-15,-19,-22[14]/46, XX[6].
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Karyotyping showed an abnormal result, including loss of chromosomes 19 and 22 and deletion of 1p, in addition to other abnormalities (Fig. 5).