PMC6702892_01
Chest X-ray revealed a large soft-tissue opacity over the medial aspect of the left upper zone.
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The initial chest radiograph [Figure 1] revealed a large soft-tissue opacity over the medial aspect of the left upper zone.
Sagittal (a), coronal (b), and axial (c) computed tomography images showed a lobulated heterogeneously enhancing soft-tissue mass in the anterior mediastinum in the left upper hemithorax, partially encasing the arch of the aorta, almost completely encasing the left common carotid artery and fully encasing the left subclavian artery. This mass also displaced the trachea and esophagus to the right. No calcification or fat densities were noted within the mass.
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There was, however, a lobulated heterogeneously enhancing soft-tissue mass seen in the anterior mediastinum, partially encasing the aortic arch, almost completely encasing the left common carotid artery and fully encasing the left subclavian artery [Figure 2]. This mass also displaced the trachea and esophagus to the right [Figure 2b and c].
Pre- (a and b) and post-chemotherapy (c and d) positron emission tomography/computed tomography images of the mediastinal mass and left cervical lymph node metastasis, showing persistent high grade F-fluorodeoxyglucose uptake of the tumor mass, as well as multiple new hypermetabolic bilateral cervical, supraclavicular and mediastinal lymph nodes metastases, suggestive of disease progression.
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Subsequently, an 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan was performed, showing the anterior mediastinal mass to be hypermetabolic with maximum standardized uptake values measuring 19.8 [Figure 3a]. A hypermetabolic left cervical lymph node metastasis was also detected [Figure 3b]. After completion of one course of chemotherapy, follow-up PET/CT scan showed persistent avid FDG uptake of the tumor mass as well as multiple new hypermetabolic bilateral cervical, supraclavicular, and mediastinal lymph nodes and new pleural metastases [Figure 3c and d], suggestive of disease progression.
Pathological examination: (a) hematoxylin and eosin stained section revealed tumor cells arranged in sheets and were large, round to oval with eccentric nuclei and deep eosinophilic cytoplasm concordant with rhabdoid morphology. The tumor cells also demonstrated malignant cytological features of pleomorphic hyperchromatic nuclei and brisk mitosis. (b) Similar features were demonstrated in the cytological imprint of H and E section. (c) On immunohistochemistry, the tumor cells showed loss of INI-1 immunostaining; the stained cells were normal cells mixed within blood vessels or inflammatory cells.
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Histopathological examination [Figure 4] revealed sheets of tumor cells composed of large, eccentric nuclei with abundant eosinophilic cytoplasmic inclusion.