case_images: PMC10858332_01
case_images: CT images of the tumor at the time of diagnosis. CT scan thorax showing a well-circumscribed tumor (arrow) in the upper lobe apicoposterior segment, right lung at diagnosis. (A) Axial view, (B) sagittal view.
case_images: cureus-0016-00000052069-i01.jpg
case_images: PMC10858332_01_cureus-0016-00000052069-i01.jpg
case_images: FIG1
case_images: Noncontrast computed tomography (NCCT) thorax was done and a large well-rounded lesion measuring 7.0x8.3x7.8cm was revealed in the right upper lobe apicoposterior segment with surrounding reactionary change in lung parenchyma (Figures 1A, 1B). After a few days, she developed pain in the back again and CT chest revealed a recurrent growth in the apical space which appeared to invade the right lung (Figure 1C).
case_images: Gross and microscopic features of the tumor. (A) Gross picture: well-circumscribed nodular tumor with solid, grey-white, fleshy partly myxoid cut surface. (B) Low power view of tumor, infiltrating lung alveolar spaces, H&E, x100. (C) Tumor showing neutrophilic collections, H&E, x400. (D) Tumor comprising fascicles of spindle cells infiltrated by inflammatory cells with occasional mitosis, H&E, x400.
case_images: cureus-0016-00000052069-i02.jpg
case_images: PMC10858332_01_cureus-0016-00000052069-i02.jpg
case_images: FIG2
case_images: The mass was received in two fragments, encapsulated and lobulated; the cut surface was grey-white, solid, homogeneous, and mostly fleshy with patchy myxoid areas (Figure 2A). Hematoxylin and eosin (H&E) stained sections revealed interlacing fascicles of spindle cells with minimal pleomorphism, admixed with inflammatory cells, mostly lymphocytes, plasma cells, and interspersed collections of neutrophils. (Figures 2B-2D). Infiltration into lung parenchyma could be appreciated in sections (Figure 2B).
case_images: Microscopic and IHC features of the recurrent tumor. (A) High power view of tumor on recurrence, H&E, x400. (B) Tumor cells showing vimentin positivity IHC, x400. (C) Tumor cells showing SMA positivity IHC, x400. (D) Tumor cells showing diffuse ALK positivity IHC, x400.
case_images: cureus-0016-00000052069-i03.jpg
case_images: PMC10858332_01_cureus-0016-00000052069-i03.jpg
case_images: FIG3
case_images: On microscopic examination sections from all of them showed a highly cellular spindle cell tumor with mild nuclear atypia, necrosis, and scattered mitotic figures (Figure 3A). IHC revealed diffuse strong ALK 1 (CD246) positivity along with vimentin and SMA positivity with 20%-30% Ki 67 labeling index (Figures 3B-3D).
case_images: CEMRI image showing metastatic lesion in brain(arrow)
case_images: cureus-0016-00000052069-i04.jpg
case_images: PMC10858332_01_cureus-0016-00000052069-i04.jpg
case_images: FIG4
case_images: After two months, she developed headaches and vomiting, and a contrast-enhanced MRI (CEMRI) of the brain revealed multiple supratentorial metastatic lesions (Figure 4).