PMC9999020_01
Imaging findings. (A) Axial non-contrast T1-weighted breast MRI image shows no evidence of malignancy. There is a mediastinal shift with the heart shifted to the right and a lack of lung markings in the upper left lung, suggesting the possibility of bulla in the upper left lung. (B) Chest X-ray shows a left-sided pneumothorax with cardiac and mediastinal shift rightward suggesting underlying tension component. (C) Chest CT shows a small left anterior pneumothorax. There is a left-sided pleural drainage catheter with its tip along the left major fissure. There are subtle patchy consolidative opacities in the subpleural aspects of the left upper lobe.
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Breast MRI showed no evidence of malignancy but was significant for a mediastinal shift with the heart shifted to the right ( Figure 1A ). Chest X-ray (CXR) confirmed left PTX with slight cardiac and mediastinal shift rightward suggesting underlying tension component ( Figure 1B ). As a chest tube placement did not produce complete resolution of the PTX ( Figure 1C ) and she endorsed a persistent air leak, a video assisted thoracoscopic surgery (VATS) was performed for pleurodesis. There were rare apoptotic bodies and rare mitotic figures (1 per 10 high power fields).
Pathological features. The tumor is represented by cystic and solid components (A); HE original magnification x5. The solid component is composed of spindle cells forming fascicles (B); there is variable background collagen deposition; HE original magnification x20. The tumor cells are immunoreactive with bcl2 (C) and SS18-SSX (D) antibodies; immunohistochemistry, original magnification x20 and x20.
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On light microscopic examination, the lesion was represented by small cysts associated with spindle cell proliferation of variable cellularity ( Figure 2A ). The spindle cells were arranged in fascicles ( Figure 2B ). The tumor cells were immunoreactive with CD56, BCL2 and SS18-SSX (clone E9X9V, Cell Signaling Technology, Danvers, MA) ( Figures 2C, D ).