PMC6613054_01
Right lung: large masses are visualized at the apex of the right lung.
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The dissected mass was chalky white and fleshy consistent with necrosis (Figure 1).
Left lung: left lower lobe tracheobronchial tree is seen, with 2 discrete malignant appearing lung masses.
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Similarly, the left lung had 3 masses appearing, the largest being 3.1 x 3.0 x 2.2 cm (Figure 2).
Left lung poorly differentiated large cells with vesicular nuclei, prominent red nucleoli, binucleated to multinucleated bizarrely shaped cells.
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On hematoxylin and eosin-stained slides, the tumor cells had poorly differentiated pleomorphic cells with large vesicular nuclei, prominent red nucleoli, and binucleated to multinucleated bizarre shapes (Figure 3).
CAM stain: tumor cells showed strongly positive cytoplasmic staining with keratin CAM 5.2.
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IHC staining of tumor cells showed strongly positive cytoplasmic staining with keratin CAM 5.2 (Figure 4).
Hypercellular bone marrow consistent with leukamoid reaction.
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Furthermore, despite prior "dry tap," the bone marrow was hypercellular with exuberant leukemoid reaction and metastatic large cell neoplasm (Figure 5).
Right mandibular malignant lesion.
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Interestingly, the presumed right mandibular abscess identified on CT scan was confirmed to be a large cell neoplasm with strongly necrotic tissue (Figure 6).
Microscopic and gross imaging of submandibular lymph node consistent with metastatic disease.
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Submandibular and parabronchial lymph nodes on the right were positive for metastatic large cell neoplasm (Figure 7); however, lymph nodes on the left were not consistent with metastatic disease.
Splenomegaly was noted.
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The spleen was large with markedly congested parenchyma with rare atypical cells but without infarction (Figure 8).
Right (right) and left (left) adrenal glands noted to be pink-brown in color with a cut surface has a thin rim of yellow-brown cortex with a multinodular heterogeneous mass that is white to fleshy to hemorrhagic and necrotic.
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Both adrenal glands had multiple metastatic nodules, hemorrhage, and diffuse necrosis (Figure 9).