case_images: PMC10563466_01
case_images: (A) Hematoxylin and eosin, magnification 100x. Biopsy cores from the left infrahilar lymph node show metastatic poorly differentiated carcinoma. (B) Hematoxylin and eosin, magnification 400x. Intercellular bridging is seen focally between tumor cells. (C-G) Cytokeratin AE1/AE3, CK5/6, GATA-3, p40, and p63 immunostains, magnification 100x. The tumor cells are positive for cytokeratin AE1/AE3, CK5/6, and GATA-3. There is focal weak staining for p40 and p63.
case_images: 10.1177_23247096231205348-fig1.jpg
case_images: PMC10563466_01_10.1177_23247096231205348-fig1.jpg
case_images: fig1-23247096231205348
case_images: However, the immunostain was also GATA-3 positive, which was not seen on the prior biopsy (Figure 1).
case_images: Computed tomographic angiography of the thorax in the axial (top row), coronal (bottom left), and sagittal (bottom right) planes. The enlarged aortopulmonary lymph node is visualized measuring 3.5 cm in the greatest transverse diameter. A large, isodense mass of the pericardial space is visualized with central calcifications and necrosis. There is encasement of the left atrium/ventricle and left main pulmonary artery and its segmental branches. No atrial appendage or pulmonary artery compression is visualized. Airspace opacities are visualized in the inferior portion of the left upper lobe with surrounding large left-sided pleural effusion.
case_images: 10.1177_23247096231205348-fig2.jpg
case_images: PMC10563466_01_10.1177_23247096231205348-fig2.jpg
case_images: fig2-23247096231205348
case_images: He underwent computed tomography angiography (CTA) of the thorax, which was negative for pulmonary embolism and showed large bilateral pleural effusions, cardiac/Aortopulmonary (AP) window region masses with mass effect on the left heart measuring 6.3 to 7.5 cm along with retroperitoneal and mediastinal masses (Figure 2).
case_images: (A) Hematoxylin and eosin, magnification 100x. Biopsy cores from the mediastinal mass show metastatic poorly differentiated carcinoma. (B) Hematoxylin and eosin, magnification 400x. Intercellular bridging is seen focally between tumor cells.
case_images: 10.1177_23247096231205348-fig3.jpg
case_images: PMC10563466_01_10.1177_23247096231205348-fig3.jpg
case_images: fig3-23247096231205348
case_images: The patient subsequently underwent image-guided biopsy and fine needle aspiration (FNA) of mediastinal mass, which showed poorly differentiated carcinoma with morphology resembling left infrahilar lymph node biopsy performed 2 years ago, consistent with metastatic carcinoma of penile primary (Figure 3).