August 2009 - Presented by Phillip Starshak, M.D.

Clinical history:

The patient is a 63 year-old male who presented to the emergency room because of sharp chest pain radiating to the scapula. A chest x-ray revealed a widened mediastinum and a CT angiogram confirmed a type B dissection of the thoracic aorta. Incidentally found was a well-circumscribed enhancing mass in the upper right hilum measuring 2.4 x 2.8 cm. A subsequent PET/CT scan was done which demonstrated hypermetabolism of this mass with a SUV of 5.7 but no areas suspicious for metastatic disease. The patient was taken to the OR for resection of this mass via right lobectomy.

CT scan image

CT Scan 

Gross description:

At the hilum was a well-circumscribed round shaped mass measuring 3.4 x 3.0 x 2.6 cm with tan-white cut surfaces. The mass protruded in to the lumen of the bronchus (no gross photos available).

Immunohistochemical stains:

  • Thyroglobulin: Negative
  • Synaptophysin Negative
  • TTF-1: Negative
  • SMA: Highlights virtually all the nests of cells

Special stains:

  • PAS with diastase: Positive
  • Mucicarmine: Positive

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