case_images: PMC10973772_01
case_images: Clinical images and pathological findings of the lung and stomach. (a) Contrast-enhanced computed tomography (CT) demonstrated the absence of lymphadenopathy, interstitial pneumonia, or lung cancer. (b) Dual-energy CT imaging revealed wedge-shaped areas of iodine deficiency (indicated by the white arrow) and diffuse impairment of lung perfusion. (c) Abdominal contrast-enhanced CT revealed liver cysts; however, no signs of malignancy or adenopathy were observed. (d) Pulmonary angiography (PAG) of right pulmonary artery. (e) PAG of left pulmonary artery. PAG did not reveal characteristic findings of chronic thromboembolic pulmonary hypertension, such as webs or bands. (f) Postmortem pathological examination showing pulmonary arterioles with adenocarcinoma cells, fibrin, and neutrophils. Asterisk denotes pulmonary artery intimal thickening (Hematoxylin and Eosin [H&E] stain). (g) Signet ring cells can be seen within and adjacent to the pulmonary artery (H&E stain). (h) The pulmonary artery shows organized thrombus and recanalization, representative findings of pulmonary tumor thrombotic microangiopathy (H&E stain; scale bar). (i) Tumor cell infiltration within the lymphatic vessels in the lungs (arrow) (D2-40 stain). (j) The macroscopic examination of the stomach did not reveal any evidence of malignancy. However, upon subsequent microscopic evaluation, a gastric tumor with a maximum diameter of 40 mm was identified. The region enclosed by the white dotted line corresponds to the occult tumor. During the grossing process in the pathological dissection, the gastric tumor inadvertently separated into two distinct parts. (k) Microscopic image of stomach reveals tumor cell infiltration to the submucosa, a finding of early gastric cancer (H&E stain). (l) Proliferation of irregularly fused glands and signet ring cells, representative findings of moderately to poorly differentiated adenocarcinoma of the stomach (Cytokeratin AE1/AE3 stain). (m) Tumor cell infiltration within the lymphatic vessels in the stomach (arrow) (D2-40 stain). The scale bar denotes 250 microm.
case_images: PUL2-14-e12359-g001.jpg
case_images: PMC10973772_01_PUL2-14-e12359-g001.jpg
case_images: pul212359-fig-0001
case_images: Dual-energy CT imaging revealed wedge-shaped iodine-deficient and diffusely impaired lung perfusion (Figure 1a-c). PH, with mean pulmonary artery pressure of 60 mmHg, pulmonary vascular resistance of 32.9 wood units, and cardiac index of 0.95 L/min/m2. Pulmonary angiography demonstrated delayed pulmonary blood flow and poor subpleural perfusion diffusely (Figure 1d,e). Pathological findings of the pulmonary artery showed intravascular cancer cells, fibrin thrombi, intimal fibrocellular proliferation with recanalization, and significant luminal stenosis with an organized thrombus (Figure 1f-i). Further microscopic pathological evaluation of multiple gastric serial sections revealed that the primary cancer was an early gastric SRCC spreading from the lamina propria to the submucosa with lymphatic invasion, and the pathological TNM staging was classified as pT1bN1M1 (Figure 1j-m).