PMC5902098_01
(a) Lung lesion histology (H&E, 200x); (b) cytokeratin-7 immunohistochemical stain; (c) immunohistochemical stain; (d) CA19-9 immunohistochemical stain (200x for all IHC stains).
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fig1
The cytomorphologic results were consistent with a metastatic process of pancreatic origin (Figure 1). The serum CA19-9 was elevated at 737 U/mL.
Chest CT showing scattered ground glass opacities and bilateral pleural effusions.
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fig2
Axillary and mediastinal lymphadenopathy and hepatic metastases were unchanged from 10 days priorly (Figure 2).
Pleural fluid involved by pleomorphic tumor cells. (a) Wright-Giemsa stain; (b) Romanowsky stain; (c) Papanicolaou stain, 400x.
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fig3
The pleural fluid showed vacuolated tumor cells with hyperchromatic irregular nuclei with anisonucleosis and prominent nucleoli consistent with adenocarcinoma (Figure 3).
Chest CT showing diffuse ground glass opacities and new interlobular interstitial thickening.
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fig4
There was no change in the extensive thoracic and abdominal metastatic lymphadenopathy (Figure 4).