case_images: PMC11187076_01
case_images: (A) Chest CT showed a mass in the right upper lobe measuring approximately 6.3 x 5.7 x 4.3 cm with a cavity. (B) Inflammation in the right upper and middle lobes.
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case_images: f1
case_images: Chest computed tomography (CT) revealed a mass in the right upper lobe, with a cavity ( Figure 1A ) and inflammation ( Figure 1B ).
case_images: (A) PET/CT demonstrated the mass in the right upper lobe with a maximum SUV of 44.67. (B) Right lung hilar lymph node metastasis could not be excluded. (C) No distant organ metastasis was observed.
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case_images: f2
case_images: Positron emission tomography/CT (PET/CT) showed the mass in the right upper lobe with a maximum standardized uptake value (SUV) of 44.67 ( Figure 2A ), and a right lung hilar lymph node metastasis could not be excluded ( Figure 2B ). No distant organ metastasis was observed ( Figure 2C ).
case_images: Pathological features. (A) Stained with hematoxylin and eosin. (B) Immunohistochemistry showed BRG1 is negative. (C) CK 19 and (D) CK (pan) were focally positive. (E) INI-1, (F) EMA, and (G) Vimentin were positive. (H) The proliferation index Ki-67 was 90%.
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case_images: f3
case_images: Histopathological examination of the surgically resected specimen revealed undifferentiated tumor cells with eosinophilic cytoplasm, eccentrically located vesicular nuclei, prominent nucleoli, and frequent mitoses ( Figure 3A ), similar to SMARCA4-deficient thoracic sarcoma. CK7. CK19 ( Figure 3C ) and CK (pan) cells ( Figure 3D ) were focally positive. Tumor cells were positive for integrase interactor 1 (INI-1) ( Figure 3E ), epithelial membrane antigen (EMA) ( Figure 3F ), and vimentin ( Figure 3G ). Additionally, the proliferation index Ki-67 ( Figure 3H ) was 90% in the tumor cells.
case_images: Four months after the operation, the tumor recurred and invaded the adjacent ribs.
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case_images: f4
case_images: Although no recurrence was observed two months postoperatively, the tumor reappeared and invaded the adjacent ribs four months after the operation ( Figure 4 ).