case_images: PMC11236686_01
case_images: Initial chest x-ray with left pleural effusion.
case_images: fsurg-11-1393159-g001.jpg
case_images: PMC11236686_01_fsurg-11-1393159-g001.jpg
case_images: F1
case_images: The initial chest x-ray (see Figure 1) showed a left pleural effusion, which was managed by placing a 14 French chest tube in the left pleural cavity using the Seldinger technique.
case_images: Image of the 1st video-assisted thoracoscopic surgery (VATS) after pleural biopsy showing abnormalities in the parietal pleura.
case_images: fsurg-11-1393159-g002.jpg
case_images: PMC11236686_01_fsurg-11-1393159-g002.jpg
case_images: F2
case_images: Lesions of the parietal pleura were subsequently diagnosed (Figure 2).
case_images: (A) Pleura visceralis with evidence of reactive proliferated mesothelia which are cytoplasmically labelled with antibodies against calretinin (calretinin (ZM85), 1:150 dilution, ZETA corporation, monospecific mouse-AK, IgG1/k; 200x magnification). (B) Pleura viszeralis showing proliferating mesothelia stained positive for panzytokeratin (Anti-Humanic Cytokeratin (pan), 1:75 dilution, Zytomed, AE1/AE3, mouse IgG1/k mouse IgG1/k; 200x magnification). (C) According to the immunstaining proliferating cells express WT-1 (WT49, 1:10 dilution, Leica; 200x magnification). (D) No immunohistological marking of the tumor cells with Ber-EP4 (EpCAM, Ber-EP4 (4), 1:100 dilution, DAKO; 200x magnification) which ruled out mesothelioma.
case_images: fsurg-11-1393159-g003.jpg
case_images: PMC11236686_01_fsurg-11-1393159-g003.jpg
case_images: F3
case_images: The immunohistological findings were suggestive of reactive proliferation, and neoplastic proliferation was consequently excluded (Figure 3).
case_images: (A) Benign CD31-positive endothelia in the lower third of the image. In the upper 2 thirds of the image strongly CD31-positive epitheloid endothelial cells of the angiosarcoma (CD31 (JC70A), ready-to-use, Leica; 200x magnification. (B) Strong nuclear ERG staining of epitheloid tumor cells (EP111, ready-to-use, DAKO, 400x magnification). (C) Strong diffuse cytoplasmic staining of the neoplastic cells with antibodies against D2-40 (podoplanin, D2-40 (7), 1:50 delution, DAKO; 400x magnification). (D) Focal Ki67-proliferation rate of 80% (SP6, 1:100 delution, rabit IgG, Zytomed; 200x magnification).
case_images: fsurg-11-1393159-g004.jpg
case_images: PMC11236686_01_fsurg-11-1393159-g004.jpg
case_images: F4
case_images: The final diagnosis was pleural manifestation of epithelioid angiosarcoma (Figure 4).