PMC4688063_01
Frontal view of the chest radiograph shows a well-circumscribed round mass in the right lower lung.
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F1
A pre-operative chest radiograph revealed a 5.3 cm well-circumscribed coin-like mass in the right lower lung [Fig 1].
Contrast-enhanced axial CT image of the right middle lobe mass. The mass shows tortuous vessels (arrowhead) in the peripherally enhancing component (arrow) and non-enhancing central component (*).
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F2
Subsequent contrast enhanced CT chest [Fig 2] showed a 4.5 x 3.8 x 3.9 cm, partially enhancing mass in the right middle lobe, abutting the oblique fissure, right diaphragm, and right lateral pleura. A PET-CT scan [Fig 3] showed FDG avidity at the periphery of the right middle lobe mass with SUVmax 3.7 and a central photopenia corresponding to the central nonenhancing component on CT [Fig 2] and FDG avidity in the left breast mass with SUVmax 3.8.
Fused axial PET/CT image showing FDG avidity with central photopenia in the right middle lobe mass with SUV 3.7 (arrow). Left breast Phyllodes tumor also shows FDG avidity with SUV 3.8 (arrowhead).
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F3
A PET-CT scan [Fig 3] showed FDG avidity at the periphery of the right middle lobe mass with SUVmax 3.7 and a central photopenia corresponding to the central nonenhancing component on CT [Fig 2] and FDG avidity in the left breast mass with SUVmax 3.8.
Gross pathology specimen. The tumor is gray-tan well defined rubbery and measures 4.5 x 4.1 x 3.3 cm. No necrosis is identified.
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Grossly, the tumor was well-defined, gray tan measuring 4.5 x 4.1 x 3.3 cm. [Fig 4].
Histology (H&E stain 100x). The tumor cells are monotonous with round uniform low grade nuclei growing in a peri-vascular fashion. No mitotic activity is apparent.
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Microscopically, it was composed of epithelioid smooth muscle cells with a low mitotic rate 1/50 HPF and uninvolved resection margins [Fig 5].
Immunohistochemistry (100x). The smooth muscle actin (SMA) stain is diffusely positive in tumor cells.
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Immunohistochemical analysis showed positivity for smooth muscle actin [Fig 6], collagen IV, CD 34 (focal and strong), and BCL-2 (diffuse and strong) [Fig 7] expression.
Immunohistochemistry (100x). Tumor cells show strong cytoplasmic staining with BCL2.
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Immunohistochemical analysis showed positivity for smooth muscle actin [Fig 6], collagen IV, CD 34 (focal and strong), and BCL-2 (diffuse and strong) [Fig 7] expression.