PMC3565149_01
Chest X-ray and chest computed tomography (CT) at admission. (A) Chest X-ray showing a large pleural effusion in the left hemithorax. (B-D) Chest CT, showing a huge pleural mass with pleural effusion in the left hemithorax (B), a pulmonary nodule in the left upper lobe (C, arrow), and a right pleural nodule (D, arrow).
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F1
A chest radiograph obtained upon admission showed a large pleural effusion in the left lung (Fig. 1A). Computed tomography (CT) images of the thorax showed a large enhancing pleural mass with pleural effusion in the left hemithorax, a 1.6 x 1.3 cm pulmonary nodule in the left upper lobe (LUL), and a right lower pleural nodule (Fig. 1B-D).
Positron emission tomography-computed tomography (PET-CT) scans. (A) A focal hypermetabolic nodular lesion is seen in the left upper lobe. (B) A large pleural effusion with heterogeneous minimal-to-mild hypermetabolic activity is seen in the left lower lobe. (C) Minimal hypermetabolic nodular lesion is seen in right lower pleural surface (arrow). No other hyperrmetabolic lesions suggesting a primary tumor are seen in this PET-CT image.
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F2
No extrapulmonary lesions were seen on the PET-CT images (Fig. 2).
Light microscopy features of the resected pleural and renal tumors. The renal tumor was resected in another hospital 20 yr previously and diagnosed as a low-grade clear cell renal cell carcinoma. (A) The pleural tumor shows an organoid or nesting arrangement of cells with a pseudoalveolar pattern. The tumor cells are separated by fibrovascular septa and delicate capillary-sized vascular channels (H&E, x 200). (B) The cytoplasms of the tumor cells are D-PAS positive (D-PAS, x 200). (C) Immunohistochemistry of the pleural tumor. The nuclei are positive for TFE3 (TFE3, x 400). (D) The tumor cells of right renal mass have clear cytoplasms, distinct cell borders, and small nuclei. The cells are arranged in small solid nests (H&E, x 200).
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F3
The cytoplasm was abundant and appeared granular and sometimes vacuolated (Fig. 3A). Under Periodic acid Schiff staining with diastase treatment (D-PAS), abundant PAS-positive granules appeared in the tumor cells (Fig. 3B). The immunohistochemistry results were positive for TFE3 (Fig. 3C) and vimentin; equivocal for CD56, chromogranin, synaptophysin, and WT-1; and negative for epithelial membrane antigen (EMA), cytokeratin (CK), CK5/6, CK7, CK20, CD10, CD30, CD34, CD68, calretinin, CEA, smooth muscle actin (SMA), desmin, HMB-45, and S-100 protein. They were arranged in small solid nests (Fig. 3D).
Electron micrograph, showing cells containing numerous mitochondria, prominent rough endoplasmic reticulum, well-developed Golgi complexes, and many membrane-bound electron-dense granules.
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