case_images: PMC2851579_01
case_images: A CT scan with contrast of the chest showing large left upper lobe lung mass involving the pleural surface.
case_images: 1746-1596-5-11-1.jpg
case_images: PMC2851579_01_1746-1596-5-11-1.jpg
case_images: F1
case_images: Due to his chest symptoms, he had a chest x-ray followed by Computerized Tomography (CT) scan of the chest which showed a left upper lung mass (4.5 x 5.5 x 5 cm) with mediastinal and right hilar adenopathy [Fig.1].
case_images: A GMS stain showing aspergillus fungal hyphae with uniform septated hyphae, and branching at 45 degrees (x100, Gomori Methanamine Silver stain).
case_images: 1746-1596-5-11-2.jpg
case_images: PMC2851579_01_1746-1596-5-11-2.jpg
case_images: F2
case_images: On Gomori Methanamine Silver (GMS) stain, the hyphae had uniform diameter, septation and branching at 45 degree, morphologically compatible with aspergillus species [Fig. 2].
case_images: Carcinosarcoma with areas of sarcomatous spindle cell proliferation (left) and an epithelial carcinoma component (right). (x100, Hematoxylin and Eosin).
case_images: 1746-1596-5-11-3.jpg
case_images: PMC2851579_01_1746-1596-5-11-3.jpg
case_images: F3
case_images: Interestingly, final surgical pathology examination revealed a poorly differentiated biphasic malignant neoplasm with epithelial and spindle cell components and necrosis [Fig. 3].
case_images: Epithelial carcinoma component of the tumor positive for cytokeratin AE1/AE3 immunostain (x100).
case_images: 1746-1596-5-11-4.jpg
case_images: PMC2851579_01_1746-1596-5-11-4.jpg
case_images: F4
case_images: The epithelial carcinomatous tumor cells showed strong immunoreactivity with pankeratin AE1/AE3 (Fig. 4) and epithelial membrane antigen (EMA) (Fig. 5) and focally for
case_images: Sarcoma component of the tumor showing spindle tumor cells positive for vimentin (x400).
case_images: 1746-1596-5-11-6.jpg
case_images: PMC2851579_01_1746-1596-5-11-6.jpg
case_images: F6
case_images: P63; while vimentin stain was strongly positive in the spindle cell component but not in the carcinomatous component [Fig. 6]. Patchy foci of spindle tumor cells were reactive for calponin and smooth muscle actin.
case_images: An area of the tumor showing hemorrhagic infarction and shadow outlines of destructed blood vessels (x100, Hematoxylin and Eosin).
case_images: 1746-1596-5-11-7.jpg
case_images: PMC2851579_01_1746-1596-5-11-7.jpg
case_images: F7
case_images: Within the resection specimen areas of infarction and coagulative necrosis were identified, some of them bordering viable tumor (Fig. 7).
case_images: Groups of aspergillus fungal hyphae are present in an area of hemorrhagic infarction in the resected specimen (x400, Gomori Methanamine Silver stain).
case_images: 1746-1596-5-11-8.jpg
case_images: PMC2851579_01_1746-1596-5-11-8.jpg
case_images: F8
case_images: In one such area, fungal hyphae morphologically consistent with aspergillus species were seen and confirmed by GMS fungal stain (Fig. 8).