case_images: PMC10547894_01
case_images: Initial coronal (A) and axial (B) computed tomography pulmonary angiogram reconstruction of the chest performed showing a mass in upper left paratracheal side (white arrow in A, B) associated with multiple randomly distributed nodules in the lung parenchyma (black arrow in C, D), the largest of them in the middle third of the lung right, enlarged lymph nodes in the para-aortic chain and thin left pleural effusion (black asterisk in C, D).
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case_images: PMC10547894_01_fonc-13-1260844-g001.jpg
case_images: f1
case_images: Computed tomography (CT) of the chest showed a solid, calcified, upper left paratracheal lesion (191 cm3) with central necrosis in close contact with the ipsilateral subclavian artery without a cleavage plane, in addition to multiple randomly distributed nodules in the lung parenchyma and enlarged lymph nodes in the para-aortic chain and thin left pleural effusion ( Figure 1 ).
case_images: Histological sections of lung biopsy showing in hematoxylin-eosin staining the presence of clear cell tumors represented by epithelioid cells with abundant clear and granular cytoplasm, with well-delimited cell borders and round and hyperchromatic nuclei, discreet cell atypia and absence of significant mitotic activity (A). The immunohistochemical study revealed co-expression of markers: HMB45 (B), smooth muscle actin (C), Melan-A (D) and Cathepsin K (E), and negativity for cytokeratins CK7, CK8 and CK20 (F, G, H, respectively).
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case_images: PMC10547894_01_fonc-13-1260844-g002.jpg
case_images: f2
case_images: The anatomopathological examination of the transbronchial biopsy showed the presence of neoplasia caused by epithelioid cells with abundant clear and granular cytoplasm, well-defined cell borders, and round and hyperchromatic nuclei, without the presence of prominent nucleoli ( Figure 2 ).
case_images: Radiographic images showing extensive pulmonary masses on chest X-ray (A) and computed tomography of the chest in coronal (B) and axial planes (C, D), suggesting disease progression. A solid tumor, calcified upper left parasternal lesion with central necrosis, close contact with ipsilateral subclavian artery, without a cleavage plane and a tumor with similar characteristics on the lower right.
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case_images: PMC10547894_01_fonc-13-1260844-g003.jpg
case_images: f3
case_images: Chest radiography and CT revealed a significant progression of the lung masses ( Figure 3 ).
case_images: Timeline from the initial clinical presentation and tests performed for the diagnosis of clear cell tumors of the lung. The time of chemotherapy, radiotherapy and hospitalization until the outcome of the case are also specified.
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case_images: PMC10547894_01_fonc-13-1260844-g004.jpg
case_images: f4
case_images: A timeline specifying the entire clinical evolution of the patient is shown in  Figure 4 .