PMC4927215_01
(a) A transverse cut in CT scan of the chest showing enlarged right paratracheal lymph node (white arrow) and (b) a coronal cut in CAT scan of the chest showing enlarged right paratracheal lymph node (white arrow) and enlarged right hilar lymph node (black arrow).
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Computed tomography of his chest images is shown in Figure 1.
Endobronchial ultrasound view of the right paratracheal lymph node with transbronchial needle aspiration.
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The patient subsequently underwent endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) of right paratracheal lymph node station 4R (Figure 2).
Biopsy of right paratracheal lymph node showing large, loosely cohesive sheets of tumor linked by "traversing vessels" with numerous "naked nuclei" present in between the tumor sheets. The tumor cells have round to oval nuclei with prominent nucleoli and abundant cytoplasm.
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Numerous nuclei stripped of cytoplasm were present in the background of the smears (Figure 3).
Biopsy of right paratracheal lymph node (cell block, hematoxylin-eosin, original magnification x20) showing aggregates of macrophages with anthracotic pigment (yellow arrow) adjacent to a small number of lymphocytes (green arrow). The other much larger cells are tumor cells.
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The specimen did not contain appreciable lymphoid tissue, but small aggregates of macrophages with anthracotic pigment were present; these macrophages indicate that the tumor was located within a mediastinal lymph node (Figure 4).
Biopsy of right paratracheal lymph node (cell block, HepPar1 immunostain, original magnification x20) showing HepPar1 positivity (brown staining) in the tumor cells. A thin-walled blood vessel is highlighted by the arrow; this is the equivalent of the "traversing vessels" seen on smears.
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Immunohistochemical stains were positive for hepatocyte paraffin 1 (HepPar1) (Figure 5) and alpha-fetoprotein (AFP), and stains for cytokeratin (CK)-7, CK-20, thyroid transcription factor-1 (TTF-1), and monoclonal carcinoembryonic antigen (CEA) were all negative.