PMC4718123_01
(a) Chest radiograph showed lung consolidation over the right lower lung field with moderate pleural effusion. (b) Chest computed tomography revealed a tumor in the right main bronchus (arrow) and right lower lobe of the lung, with mediastinum and adjacent organ involvement. (c) Bronchofiberscopy showed a polypoid tumor with whitish tissue coating and erosion over the orifice of the right main bronchus. (d) Easy bleeding of the tumor after bronchofiberscopic biopsy.
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A chest radiograph showed lung consolidation over the right lower lung field, associated with pleural effusion (Fig 1a). Chest computed tomography (CT) revealed a tumor in the right main bronchus and lung, with mediastinum involvement and regional lymphadenopathy, leading us to suspect an advanced lung cancer, such as a small cell carcinoma (Fig 1b). Bronchofiberscopy showed a polypoid tumor with erosion over the right main bronchus (Fig 1c,d).
(a) Tissue showed extensive necrosis (hematoxylin & eosin [H&E] stain, magnification, 100x). (b) The diffusely infiltrative small to medium-sized tumor cells had irregular nuclear contours, condensed chromatin, inconspicuous nucleoli, and pale cytoplasm. Mitotic figures were easily found, including atypical form (arrow) (H&E 400x). (c) By immunohistochemistry, the tumor cells were positive for cytoplasmic CD3epsilon (400x). (d) Positive for CD56 (400x). (e) Positive for granzyme B (400x). (f) In situ hybridization for Epstein-Barr virus encoded ribonucleic acid was positive (400x).
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Histologically, the tissue showed extensive necrosis (Fig 2a). Mitotic figures were easily found, including atypical forms (Fig 2b). Using immunohistochemistry, the tumor cells were positive for CD2, cytoplasmic CD3epsilon (Fig 2c), CD56 (Fig 2d), and granzyme B (Fig 2e), but were negative for cytokeratin (AE1/AE3), CD4, CD8, and CD20, indicating NK/T cell lineages of the neoplastic cells. The neoplastic NK/T cells were positive for Epstein-Barr virus encoded ribonucleic acid (EBER) in situ hybridization (Fig 2f), but no CD20 positive B-cells were present.