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Case 2
“Mediastinic neoformation”
Stefano Crippa – Istituto Cantonale di Patologia - Locarno (Switzerland)
(Pictures by Dr. Crippa)
Clinical history
Un uomo di 53 anni viene sottoposto ad intervento chirurgico per la presenza di massa mediastinica infiltrante il lobo inferiore del polmone destro e la vena polmonare. Durante l'intervento chirurgico sono state effettuate alcune macrobiopsie per un esame estemporaneo con conseguente diagnosi di “neoplasia maligna a cellule fusate a crescita solida”. Il chirurgo procede all'asportazione del lobo polmonare inferiore destro.
Macroscopical description
A lung lobe with lacerations of the visceral pleura. In correspondence to this was a greyish-brown neoplasia with a 4cm diameter infiltrating the parenchyma.
Microscopical description
the neoplasia was composed of spindle cells with intensely eosinophilic cytoplasm,
moderate nuclear atypia and a high mitotic index
(pict. 1, pict. 2, pict. 3, pict. 4, pict. 5, pict. Pict. 1 -
Pict. 2
Pict. 3 -
Pict. 4 -
Pict. 5 -
Pict. 6)
which infiltrated the pulmonary parenchyma and had a tendency to grow around the bronchial structures (Pict. 7 -
Pict. 8 -
Pict. 9 -
Pict. 10).
The neoplastic cells were negative with immunohistochemistry stains for MNF116,
CAM5.2, CK5/6, CK34BetaE12, CK20, BerEp4,Alfa-SMA, HHF35, desmin, CD34, S100)
whilst they were focally positive for CK7 e CK19 (Pict. 11 -
Pict. 12) and
diffusely positive for calretinin, Bcl2 ed EMA (Pict. 13 -
Pict. 14 -
Pict. 15).
Diagnosis
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