PMC6538954_01
Axial image of the chest from CTA pulmonary exam shows a large filling defect in the right pulmonary artery (arrow) as compared to the normal opacification in the main pulmonary artery (asterix). The main pulmonary artery is normal in size.
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Six months prior to presentation she had been diagnosed with suspected acute pulmonary embolism involving the entire right pulmonary artery (Fig. 1).
Axial image of the chest from CTA pulmonary exam showing the large filling defect in the right pulmonary artery branches into the anterior segment of the right upper lobe and interlobar pulmonary arteries (straight arrows). The margins of the filling defect are lobulated (curved arrow). There is also subcarinal lymphadenopathy (asterix).
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The mass had progressed into the distal main pulmonary artery and its branches (Fig. 2).
60x Giemsa stain. Fine needle aspiration of right paratracheal mass shows atypical spindle cells with variable degrees of nuclear pleomorphism (thin arrow) and occasional mitotic figures (thick arrow) on this smear prep slide.
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Cytology showed tumor cells with spindle cell proliferation (Fig. 3, Fig. 4).
20x. Immunohistochemical evaluation of the cell block shows scattered nuclear reactivity to MDM2.
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Immunohistochemical studies were positive for MDM2 and negative for erythroblast transformation-specific transcription factor (ERG) (Fig. 5).
Axial image of the chest from CTA pulmonary exam shows a pleural effusion (dashed line) surrounding collapsed lung. The pulmonary artery sarcoma is seen as a lobulated expansile filling defect in the main and right pulmonary arteries (curved arrows).
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There was subtotal resorptive atelectasis of the right hemithorax with reactive loculated moderate pleural effusion. (Fig. 6).