case_images: PMC9429989_01
case_images: PMC9429989_02
case_images: specimen from bronchoscopic biopsy showing numerous hyphae with septation consistent with aspergillosis (arrows)
case_images: PAMJ-42-135-g001.jpg
case_images: PMC9429989_02_PAMJ-42-135-g001.jpg
case_images: F1
case_images: A culture of bronchoalveolar lavage fluid confirmed the presence of Aspergillus fumigatus (Figure 1).
case_images: chest computerized tomography scan showing: A) large lung soft tissue mass lesion with areas of necrosis (red dashed line); B) left inferior pulmonary vein and left atrium thrombosis (green dashed line)
case_images: PAMJ-42-135-g002.jpg
case_images: PMC9429989_02_PAMJ-42-135-g002.jpg
case_images: F2
case_images: Caspofungin administration, she presented with worsening symptoms and was admitted for further evaluation. Chest computed tomography (CT) scan showed an 8 x 4 cm heterogeneous, well-defined left lower lobe mass with areas of soft tissue enhancement and necrosis, invasion of the left atrium, the left main bronchus, and left pulmonary artery, and compression of the left inferior pulmonary vein (Figure 2).
case_images: pathologic examination showing: A) proliferating spindle cells forming interlacing bundles and high mitotic figures (HE stain x 200); B) proliferating spindle cells forming interlacing bundles and high mitotic figures (HE stain x 400); C) immunohistochemistry stain showing diffuse positivity of vimentin; D) immunohistochemistry stain showing positive smooth muscle actin
case_images: PAMJ-42-135-g003.jpg
case_images: PMC9429989_02_PAMJ-42-135-g003.jpg
case_images: F3
case_images: The tumor was negative for CKAE1/AE3, Ck7, CK5/6, EMA, Calretinin, S100, P63, CD34, BCl2, Desmin, Myogenin, and CD117 immunostains ruling out other possibilities and confirming the diagnosis of leiomyosarcoma (Figure 3).
case_images: bone scan in anterior view (A), posterior view (B), and chest oblique views (C,D) showing multiple hot spots in the inferior angle of the scapula, 10th left rib posteriorly, and the vertebral discs suggestive of metastasis (stars)
case_images: PAMJ-42-135-g004.jpg
case_images: PMC9429989_02_PAMJ-42-135-g004.jpg
case_images: F4
case_images: functional single-photon emission computed tomography images in axial view (A), coronal view (B), and sagittal view (C) showing the increased area of activity in the inferior angle of the scapula, 10th left rib posteriorly, and the vertebral discs suggestive of metastasis (arrows)
case_images: PAMJ-42-135-g005.jpg
case_images: PMC9429989_02_PAMJ-42-135-g005.jpg
case_images: F5
case_images: Figure 5). Further, imaging with an abdominal CT scan with intravenous injection revealed multiple small liver lesions suggestive of metastasis (Figure 6).
case_images: abdominal computerized tomography scan showing hepatic hypodense lesions (arrow)
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case_images: PMC9429989_02_PAMJ-42-135-g006.jpg
case_images: F6
case_images: Figure 5). Further, imaging with an abdominal CT scan with intravenous injection revealed multiple small liver lesions suggestive of metastasis (Figure 6).