case_images: PMC2627182_01
case_images: A 37-year-old woman with a primary pulmonary paraganglioma.. A. The chest radiograph shows a left hilar mass with a lobulated margin.. B, C. The contrast-enhanced CT axial images show a left hilar mass with an endobronchial protrusion, which extends along the bronchial lumen, and the mass shows mild homogeneous enhancement.. D. The lung setting image shows localized emphysema distal to the endobronchial lesion.. E. Bronchoscopy reveals a hypervascular bulging mass with a lobulated surface (arrows) in the lingular segmental bronchus.. F. Photograph of the left upper lobectomy specimen dissected along the lingular bronchial plane demonstrates a multilobulated, whitish mass (arrowheads) within a dilated left upper lobar bronchus, and this mass extends along the lingular segmental bronchus (arrows).. G. The histopathologic specimen shows that the tumor is composed of a nest of round or polygonal tumor cells separated by prominent fibrovascular septa, producing the typical "zellballen" of a paraganglioma. Also of note are the marked nuclear pleomorphism and up to one or two mitotic figures/10 HPFs, suggesting the tumor's malignant potential (Hematoxylin & Eosin staining, x200).
case_images: kjr-9-87-g001.jpg
case_images: PMC2627182_01_kjr-9-87-g001.jpg
case_images: F1
case_images: A chest radiograph showed a left hilar mass with a lobulated margin (Fig. 1A). A mildly enhancing left hilar mass with an endobronchial protrusion and an extension along the left lingular segmental bronchus was noted (Figs. 1B, C). The lung setting image showed localized emphysema distal to the endobronchial lesion (Fig. 1D). Bronchoscopy revealed a mutilobular, hypervasacular mass obstructing the lumen of the left lingular segmental bronchus (Fig. 1E). The remaining lung parenchyma showed no remarkable change (Fig. 1F). The microscopic examination revealed that the tumor consisted of nests of epitheloid cells in an organoid or alveolar pattern, and this was surrounded by a delicate, richly vascular reticulin network, producing the classic 'zellballen' or basket pattern (Fig. 1G).