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case_images: (A) Contrast-enhanced CT scan showing tumor before first surgery of the patient. The arrow represents a rim enhancement, i.e., tumor-feeding vessels around the tumor. (B) Tumor-feeding vessels originated from the inferior pulmonary vein shown by an arrow. (C) The tumor developed recurrence (b) and implant metastases on anterior (a) and posterior (c) pleura. (D) The tumor adjacent to the inferior pulmonary vein as indicated by an arrow. The tumor adjacent to the right lower lobe, right middle lobe of the lung and the diaphragm. (E) Anterior view of a three dimensional (3D) reconstruction. (F) Left view of a 3D reconstruction. Not tight junctions are indicated by the red arc. The tumor originated from posterior pleura (red triangle). Recurrent tumor (b) and implant metastatic tumors (a, c) (G) The relationship between the tumor and the vessels. The blood vessels supplying the recurrent tumor are indicated by arrows.
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case_images: Analysis of the past diagnostic imaging revealed a 20 cm x 18 cm mass lesion in the right hemithorax ( Figure 1A ). During this hospitalization, a mass tumor in the right hemithorax was found with the contrast-enhanced chest CT ( Figures 1B-D ). On diagnostic imaging, the tumor was found to originate from the visceral pleura of the right lower lung with the rim-enhancement ( Figure 1B ) and had implantation metastasis spread to the parietal pleura ( Figure 1C ). The imaging results guided the separation between the tumor and inferior pulmonary vein to avoid vessel injury ( Figure 1D ). In addition, a three-dimensional (3D) reconstruction was performed to understand the relationship between the tumor and its surrounding tissues, including blood vessels, lung and liver ( Figures 1E-G ). A 3D reconstruction of the relationship among the three tumors is shown in  Figure 1F . The blood supply of larger tumors is mainly from a pulmonary artery and vein ( Figure 1G ).
case_images: (A) Adhesion between the tumor and diaphragm as indicated by an arrow. (B) Arrow represents loose junctions between the tumor and anterior pleura.
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case_images: Magnetic resonance imaging (MRI) showed that the tumor had invaded the diaphragm and was not closely connected with parietal pleura ( Figure 2 ).
case_images: (A) The tumor arising from right lower lung. (B) Seeding tumors of anterior pleura. (C) Seeding tumors of posterior pleura. (D) Thoracoscopic view of the tumor located in the posterior pleura.
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case_images: Ultimately, we found that the tumor consisted of three parts, which adhered to the right lower lung, anterior and posterior pleura ( Figures 3A-C ). The implanted tumor mainly received blood supply from the blood vessels in the chest wall ( Figure 3D ).
case_images: (A) Tumor cells and collagen. (B) Positive immunohistochemistry staining for CD34.
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case_images: POD 7, respectively. Postoperative pathology indicating SFTP ( Figure 4 ).