PMC3350125_01
PET scan shows a localized FDG uptake in the middle third of the trachea. (a): PET, (b): CT, (c): PET-CT. (1): axial view, (2): coronal, (3): sagittal.
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fig1
On a follow-up abdominal CT, a possible liver metastasis was discovered for which a PET scan was required which showed a localized and unique FDG uptake within the middle third of the trachea (Figure 1).
CT scan. CT coronal reformation shows the longitudinal extent of the tumor, its location 35 mm above the carina, and the severity of tracheal narrowing (40%).
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fig2
Coronal reformation showed the longitudinal extent of the plasmacytoma, location of its upper part was 8.5 cm distal to vocal cords, and its distal part was 3.5 cm above the carina (Figure 2).
CT scan. Virtual endoscopy demonstrates an endoluminal view of the tracheal tumor.
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fig3
Virtual bronchoscopy demonstrated the severity of the airway narrowing (Figure 3).
Snapshot by tracheoscopy during the surgery shows an obstructive and fleshy tracheal mass.
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fig4
The endoscopic intraoperative view showed an obstructive tracheal mass with a small insertion pedicle (Figure 4).
Photomicrograph of surgical specimen. Diffuse infiltrate of neoplastic monoclonal well-differentiated plasma cells is present associated with many deposits of amyloid in the stroma (HES x200).
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fig5
The mass was excised with the extremity of the bronchoscope, and the base of insertion was coagulated with a rigid monopolar probe. The final histological examination showed a diffuse infiltrate of neoplastic monoclonal well-differentiated plasma cells (Figure 5).
Photomicrograph of surgical specimen. The plasma cells express cytoplasmic immunoglobulin with light chain restriction. They also express CD138, marker characteristically positive for plasma cells (immunohistochemistry, kappa x200).
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fig6
At immunohistochemistry the plasma cells express cytoplasmic immunoglobulin with light chain restriction and CD138, marker characteristically positive for plasma cells (Figure 6).