PMC9772396_01
(A, B) CT scans at initial examination show a white mass extending into the left main bronchus from the bronchial orifice of the left upper lobe (green arrow). (C) A CT scan just before proton therapy shows further tumour growth. (D) A CT scan for 8 months post-proton therapy shows a gradually shrinking tumour
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Computed tomography (CT) revealed a 35 x 32 x 39 mm oval mass in the left hilar region, extending into the left main bronchus (Figure 1A, B). The tumour gradually shrank to 43 x 27 x 37 mm for 8 months post-proton therapy, along with atelectasis resolution (Figure 1D).
(A, B) Bronchoscopic images at initial examination show a white mass extending into the left main bronchus from the bronchial orifice of the left upper lobe (green arrow). (C) During bronchoscopic re-examination, slight reddish appearance with blood oozing at the biopsy seemed non-necrotic tissue (white arrowhead), unlike necrotic tissue, which appears white (white arrow)
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We performed the bronchoscopy and found a white mass extending into the left main bronchus from the bronchial orifice of the left upper lobe (Figure 2A, B). As the examination progressed, it became possible to confirm the slight reddish surface and blood oozing to some degree during the biopsy (Figure 2C), so we considered that we had taken sufficient viable tissues.
Specimens obtained during the first bronchoscopy were composed of coagulative necrotic tissue (A). Haematoxylin-eosin staining of the tumour shows spindle and round-shaped atypical cells with eosinophilic cytoplasm (B). Immunohistochemistry results are positive for alpha-smooth muscle actin (C). (Original magnification: x200)
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All specimens obtained from transbronchial biopsy (TBB) were composed of coagulative necrotic tissue (Figure 3A). The former specimens were all necrotic, but the latter showed spindle-shaped and round-shaped atypical cells with eosinophilic cytoplasm (Figure 3B). Immunohistochemical analysis was positive for alpha-smooth muscle actin (Figure 3C) and HHF35, but negative for AE1/AE3, TTF-1, p40, CK5/6, and CD34, leading to a diagnosis of leiomyosarcoma.