A 58-Year-Old Woman With Back Pain and an Unusual Diagnosis

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A 58-Year-Old Woman With Back Pain and an Unusual Diagnosis Avri Bohm, MD, Saeed Asiry, MD, Adnan Hasanovic, MD, Stephen Machnicki, MD CHEST Volume 155, Issue 2, Pages e37-e42 (February 2019) DOI: 10.1016/j.chest.2018.10.045 Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 1 A, B, Frontal and lateral tomographic scout images of the chest. C-E, Noncontrast axial and coronal CT images of the chest with lung and soft-tissue windows demonstrate an ovoid-shaped nodule in the anterior segment of the right upper lobe with smooth margins and a density comparable to soft tissue. The nodule is contiguous with and narrows the adjacent right upper lobe bronchus. F, Sagittal CT image of the chest illustrates the nodule to be contiguous with the pleura of the minor fissure. CHEST 2019 155, e37-e42DOI: (10.1016/j.chest.2018.10.045) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 2 A, B, Axial 18F-FDG-fused PET/CT with soft-tissue windows and coronal MIP images of the chest demonstrate the right upper lobe nodule to be mildly FDG-avid, with uptake comparable to that of the adjacent great vessels. 18F-FDG = fludeoxyglucose 18F; MIP = maximum intensity projection. CHEST 2019 155, e37-e42DOI: (10.1016/j.chest.2018.10.045) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 3 A, B, Axial gallium 68 tetraazacyclododecane-tetraacetic acid Tyr3-octreotate–fused PET/CT and MIP images of the chest at the level of the hilum demonstrates avid uptake within the right upper lobe nodule. See Figure 2 legend for expansion of abbreviations. CHEST 2019 155, e37-e42DOI: (10.1016/j.chest.2018.10.045) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 4 A 2.7 × 2.7 × 2.6 cm, well-circumscribed nodule (yellow circle) abutting the pleura (red arrow) and adjacent to the hilar structures (green arrow). The nodule has a firm, predominantly hemorrhagic cut surface. CHEST 2019 155, e37-e42DOI: (10.1016/j.chest.2018.10.045) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 5 A, Low-power view (40×). Well-circumscribed nodule from the adjacent lung parenchyma (green star). The nodule has two components: ectatic hemorrhagic spaces (black stars) and stromal (yellow stars). B, High-power view (400×). Cuboidal surface cells were found lining ectatic hemorrhagic spaces (black arrow), whereas the stromal component was composed of round to oval cells (yellow arrows). C-D, Immunohistochemistry. Both surface cells lining the hemorrhagic spaces (red arrow) and the stromal cells (green arrows) are diffusely and strongly positive for TTF-1 immune stain. CK AE1/AE3 immunostain shows diffuse and strong immunolabeling of the surface cells lining the hemorrhagic spaces (red arrow), but negative or very focal weak immunolabeling of the stromal cells (green arrows). CHEST 2019 155, e37-e42DOI: (10.1016/j.chest.2018.10.045) Copyright © 2018 American College of Chest Physicians Terms and Conditions