case_images: PMC9999020_01
case_images: Imaging findings. (A) Axial non-contrast T1-weighted breast MRI image shows no evidence of malignancy. There is a mediastinal shift with the heart shifted to the right and a lack of lung markings in the upper left lung, suggesting the possibility of bulla in the upper left lung. (B) Chest X-ray shows a left-sided pneumothorax with cardiac and mediastinal shift rightward suggesting underlying tension component. (C) Chest CT shows a small left anterior pneumothorax. There is a left-sided pleural drainage catheter with its tip along the left major fissure. There are subtle patchy consolidative opacities in the subpleural aspects of the left upper lobe.
case_images: fonc-13-1096160-g001.jpg
case_images: PMC9999020_01_fonc-13-1096160-g001.jpg
case_images: f1
case_images: Breast MRI showed no evidence of malignancy but was significant for a mediastinal shift with the heart shifted to the right ( Figure 1A ). Chest X-ray (CXR) confirmed left PTX with slight cardiac and mediastinal shift rightward suggesting underlying tension component ( Figure 1B ). As a chest tube placement did not produce complete resolution of the PTX ( Figure 1C ) and she endorsed a persistent air leak, a video assisted thoracoscopic surgery (VATS) was performed for pleurodesis. There were rare apoptotic bodies and rare mitotic figures (1 per 10 high power fields).
case_images: Pathological features. The tumor is represented by cystic and solid components (A); HE original magnification x5. The solid component is composed of spindle cells forming fascicles (B); there is variable background collagen deposition; HE original magnification x20. The tumor cells are immunoreactive with bcl2 (C) and SS18-SSX (D) antibodies; immunohistochemistry, original magnification x20 and x20.
case_images: fonc-13-1096160-g002.jpg
case_images: PMC9999020_01_fonc-13-1096160-g002.jpg
case_images: f2
case_images: On light microscopic examination, the lesion was represented by small cysts associated with spindle cell proliferation of variable cellularity ( Figure 2A ). The spindle cells were arranged in fascicles ( Figure 2B ). The tumor cells were immunoreactive with CD56, BCL2 and SS18-SSX (clone E9X9V, Cell Signaling Technology, Danvers, MA) ( Figures 2C, D ).