case_images: PMC11763680_01
case_images: Ultrasound demonstrating a moderate left pleural effusion. Ultrasound-guided thoracocentesis was performed.
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case_images: However, by March 2023, she complained of shortness of breath and a repeat CT-scan showed a small pericardial effusion and multilobulated 4.8 x 4.2 cm left lower lobe perihilar soft tissue mass lesion (Figure 1).
case_images: CT-scan at the time of diagnosis showing a left lower lobe perihilar soft tissue mass lesion.
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case_images: By May 2024, the patient developed moderate pleural effusion and 400 cc of pale-yellow fluid was obtained by thoracentesis that was submitted for cytological analysis. (Figure 2).
case_images: Pleural fluid sample. (a) Papanicolaou stain 200x, Thin Prep. shows cellular specimen with numerous atypical clusters of cells. (b) Cell block (Hematoxylin and eosin stain) 500x. shows clusters of tumor cells consistent with metastatic adenocarcinoma. (c) TTF-1 stain 400x. Tumor cells stained with TTF-1 confirming metastatic lung adenocarcinoma. (d) PDL-1 immunostain 400x. Membrane staining of a portion of tumor cells in cell block.
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case_images: The cytological examination revealed metastatic adenocarcinoma (Figure 3a,b). TTF-1 clone 8G7G3/1 was positive, with strong nuclear staining, confirming metastasis from the lung primary (Figure 3c). The PDL-1 clone 22C3 tumor proportion score was 40% (Figure 3d).