16778410 Visualization

The patient was a 34 Age - yr Age - old Age man Sex who presented Clinical_event with complaints of fever Sign_symptom and a chronic Detailed_description cough Sign_symptom .
He was a smoker History and had a history History of History pulmonary Biological_structure tuberculosis Disease_disorder that had been treated Lab_value and Lab_value cured Lab_value .
A computed Diagnostic_procedure tomographic Diagnostic_procedure (CT) Diagnostic_procedure scan revealed multiple Detailed_description tiny Detailed_description nodules Sign_symptom in both Biological_structure lungs Biological_structure .
A thoracoscopic Detailed_description lung Biological_structure biopsy Diagnostic_procedure was taken from the right Biological_structure upper Biological_structure lobe Biological_structure .
The microscopic Diagnostic_procedure examination Diagnostic_procedure revealed a typical LCH Sign_symptom .
The tumor Coreference cells Coreference had vesicular Detailed_description and grooved Texture nuclei Biological_structure , and they formed small Biological_attribute aggregations Biological_attribute around Biological_structure the Biological_structure bronchioles Biological_structure (Fig.1).
The tumor Coreference cells Coreference were strongly Severity positive Lab_value for S-100 protein Diagnostic_procedure , vimentin Diagnostic_procedure , CD68 Diagnostic_procedure and CD1a Diagnostic_procedure .
There were infiltrations Biological_structure of lymphocytes Biological_structure and eosinophils Biological_structure around the tumor Coreference cells Coreference .
With performing additional radiologic Diagnostic_procedure examinations Diagnostic_procedure , no Sign_symptom other Sign_symptom organs Sign_symptom were Sign_symptom thought Sign_symptom to Sign_symptom be Sign_symptom involved Sign_symptom .
He quit Activity smoking Activity , but he received no other specific treatment.
He was well Sign_symptom for Duration the Duration following Duration one Duration year Duration .
After this, a follow-up CT Diagnostic_procedure scan Diagnostic_procedure was performed and it showed a 4 Shape cm Shape - sized Shape mass Sign_symptom in the left Biological_structure lower Biological_structure lobe Biological_structure , in addition to the multiple Detailed_description tiny Detailed_description nodules Sign_symptom in both Biological_structure lungs Biological_structure (Fig.2).
A needle Detailed_description biopsy Diagnostic_procedure specimen revealed the possibility Sign_symptom of Sign_symptom a Sign_symptom sarcoma Sign_symptom ; therefore, a lobectomy Therapeutic_procedure was performed.
Grossly, a 4 Shape cm Shape - sized Shape poorly Detailed_description - circumscribed Detailed_description lobulated Detailed_description gray Color - white Color mass Sign_symptom was found (Fig.3), and there were a few small Detailed_description satellite Detailed_description nodules Sign_symptom around the main Coreference mass Coreference .
Microscopically Diagnostic_procedure , the tumor Coreference cells Coreference were aggregated Detailed_description in Detailed_description large Detailed_description sheets Detailed_description and they showed an infiltrative Biological_structure growth Biological_structure .
The cytologic Biological_attribute features Biological_attribute of some of the tumor Coreference cells Coreference were similar Detailed_description to Detailed_description those Detailed_description seen Detailed_description in Detailed_description a Detailed_description typical Detailed_description LCH Detailed_description .
However, many tumor Coreference cells Coreference showed overtly malignant cytologic Biological_attribute features Biological_attribute such as pleomorphic/hyperchromatic Detailed_description nuclei Biological_structure and prominent Detailed_description nucleoli Biological_attribute (Fig.4), and multinucleated Detailed_description tumor Biological_structure giant Biological_structure cells Biological_structure were also found.
There were numerous Detailed_description mitotic Biological_structure figures Biological_structure ranging from 30 Lab_value to Lab_value 60 Lab_value per Lab_value 10 Lab_value high Lab_value power Lab_value fields Lab_value , and some Detailed_description of Detailed_description them Detailed_description were Detailed_description abnormal Detailed_description .
A few Detailed_description foci Detailed_description of typical Sign_symptom LCH Sign_symptom remained around Detailed_description the Detailed_description main Detailed_description tumor Detailed_description mass Detailed_description .
Immunohistochemically Diagnostic_procedure , the tumor cells were strongly Severity positive Lab_value for S-100 protein Diagnostic_procedure (Fig.5) and vimentin Diagnostic_procedure ; they were also positive Lab_value for CD68 Diagnostic_procedure (Dako N1577, Clone KPI), and focally Detailed_description positive Lab_value for CD1a Diagnostic_procedure (Fig.6), and they were negative Lab_value for cytokeratin Diagnostic_procedure , epithelial Diagnostic_procedure membrane Diagnostic_procedure antigen Diagnostic_procedure , CD3 Diagnostic_procedure , CD20 Diagnostic_procedure and HMB45 Diagnostic_procedure .
The ultrastructural Diagnostic_procedure analysis Diagnostic_procedure failed Sign_symptom to Sign_symptom demonstrate Sign_symptom any Sign_symptom Birbeck Sign_symptom granules Sign_symptom in the cytoplasm Biological_structure of the tumor Sign_symptom cells Sign_symptom .
Now, at five Date months Date after Date lobectomy Coreference , the patient is doing Outcome well Outcome with no Sign_symptom significant Sign_symptom change Sign_symptom in Sign_symptom the Sign_symptom radiologic Sign_symptom findings Sign_symptom .