case_images: PMC3758708_01
case_images: Cut section of the excised tumor reveals a fleshy mass with areas of hemorrhage and necrosis
case_images: JLP-5-55-g001.jpg
case_images: PMC3758708_01_JLP-5-55-g001.jpg
case_images: F1
case_images: The mass seemed to involve the medial aspect of the lobe including the hilar area with some residual remnant of parent lung in the periphery [Figure 1].
case_images: Photomicrographs of the neoplasm showing (a) fairly monomorphic tumor cells in vague lobulated sheets with pushing margins (H and E, x100), (b) fine branching blood vessels separating the tumor nests (H and E, x200), (c) areas of spindling and fascicular array (H and E, x200), (d) monomorphic poorly differentiated round cells in sheets with brisk mitosis (H and E, x400)
case_images: JLP-5-55-g002.jpg
case_images: PMC3758708_01_JLP-5-55-g002.jpg
case_images: F2
case_images: Microscopy revealed a cellular unencapsulated neoplasm with tumor cells in vague lobulated sheets with pushing margins [Figure 2a]. In most areas, the cells appeared small and round with round to ovoid nuclei and a small amount of eosinophilic cytoplasm [Figure 2d]. In only a few areas was their some degree of spindling with cells growing in fascicular arrays [Figure 2c]. In places, the cells were in nests separated by fine branching staghorn or hemangiopericytomatous type blood vessels [Figure 2b].
case_images: Immunohistochemical profile shows (a) focal positivity for pancytokeratin (b) more reactivity for epithelial membrane antibody (c) CD34 highlights the hemangiopericytomatous pattern of the blood vessels with the negative reaction of the tumor cells. (d) Tumor cells show diffuse nuclear positivity for transducer-like enhancer of split - 1 (DAB, x200)
case_images: JLP-5-55-g003.jpg
case_images: PMC3758708_01_JLP-5-55-g003.jpg
case_images: F3
case_images: TLE-1 stain was carried out, which revealed diffuse nuclear reactivity of the tumor cells [Figure 3].