case_images: PMC10791133_01
case_images: Chest CT and PET/CT. Chest CT showed decreased lung volume and hydropneumothorax (70% compression) on the right (a), scattered nodules in the left lung (b), and thickening of the right pleura (c). PET/CT showed that the right pleura which had two high metabolism nodules was mild diffuse thickened with hypermetabolism (d, e), and multiple bone destruction with hypermetabolism was located at L1 and S2 (f). L1, first lumbar vertebrae; S2, second sacral vertebrae.
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case_images: F1
case_images: However, 2 months prior, the chest CT scan revealed decreased lung volume, hydropneumothorax (70% compression) (Fig. 1a), scattered nodules in the left lung (Fig. 1b), and thickening of the right pleura (Fig.1c).
case_images: Medical thoracoscopy. Hemorrhagic hydrothorax (a), scattered hemorrhagic sites on the parietal and visceral pleura (b), and mildly adhesive and thickened pleura (c) were observed through thoracoscopy.
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case_images: F2
case_images: Positron emission tomography/CT (PET/CT) was performed, which showed two hypermetabolic nodules with mild diffuse thickening of the right pleura, and multiple destructive bone lesions were located at the first lumbar vertebrae, second sacral vertebrae, bilateral ilium, and left ischium (Fig. 2).
case_images: HE staining and immunohistochemistry. HE (x200): tumor cells in pleura (a) are more heterogeneous than those in the chest wall (b) and lung tissue (c). Pleural immunohistochemistry (x200): CD31 (+) (d), CD34 (+) (e), and ERG (+) (f).
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case_images: F3
case_images: Immunohistochemistry showed cluster of differentiation (CD) 31 (+) (Fig. 3d), vimentin (+), D2-40 (+), Ki-67 (+10%), tumor protein 53 (P53) (+), and creatine phosphokinase (CK) (-), indicating the possibility of a vasogenic tumor. Pathological hematoxylin-eosin staining showed that pleural tumor cells were more heterogeneous than those of the chest wall and lungs (Fig. 3a-c). Immunohistochemical tests revealed CD34 (+) (Fig. 3e), ERG (+) (Fig. 3f), and