case_images: PMC11320392_01
case_images: Axial and coronal CT Chest prior to (a&b) and following (c&d) neoadjuvant radiation therapy.
case_images: 10.1177_20363613241274230-fig1.jpg
case_images: PMC11320392_01_10.1177_20363613241274230-fig1.jpg
case_images: fig1-20363613241274230
case_images: The mass had continued to grow and measured 13 cm x 13  cm x 12 cm with extension into the posterior mediastinum and left hemithorax. (Figure 1) PET scan demonstrated rim-enhancement and a CT-guided core needle biopsy revealed large anaplastic cells with multinucleated hyperchromatic nuclei which stained diffusely positive for MDM2 and negative for AE1/AE3, p40, EMA, desmin, SMA, S-100, melanoma cocktail, CD 3/20/30/45, and SOX-10. (Figure 2) Further analysis revealed MDM2 amplification in 72% of cells by FISH testing. CGY over 30 fractions. CT imaging after completion revealed a slight decrease in the size of the mediastinal portion of the tumor, but enlargement of the portion in the right lower lobe. (Figure 1) Given the reduction in size of the mediastinal component, the decision was made to proceed with surgical resection.
case_images: Hematoxylin and eosin (HE) and MDM2 staining of the initial biopsy (a&b), and HE staining of the surgically resected tumor (c).
case_images: 10.1177_20363613241274230-fig2.jpg
case_images: PMC11320392_01_10.1177_20363613241274230-fig2.jpg
case_images: fig2-20363613241274230
case_images: The mass had continued to grow and measured 13 cm x 13  cm x 12 cm with extension into the posterior mediastinum and left hemithorax. (Figure 1) PET scan demonstrated rim-enhancement and a CT-guided core needle biopsy revealed large anaplastic cells with multinucleated hyperchromatic nuclei which stained diffusely positive for MDM2 and negative for AE1/AE3, p40, EMA, desmin, SMA, S-100, melanoma cocktail, CD 3/20/30/45, and SOX-10. (Figure 2) Further analysis revealed MDM2 amplification in 72% of cells by FISH testing.
case_images: Surgical specimen. Green star marking right lower lobe parenchyma, yellow circle marking transmediastinal segment of tumor, purple square marking portion of tumor in the right hemithorax.
case_images: 10.1177_20363613241274230-fig3.jpg
case_images: PMC11320392_01_10.1177_20363613241274230-fig3.jpg
case_images: fig3-20363613241274230
case_images: The entirety of the mass was removed en-bloc with adequate margin and the operation was completed without issue. (Figure 3) Final surgical pathology was ypT4 according to AJCC 8th edition staging.