Case view

Residents Special - Case 2

Description:

A 38-year old woman, non-smoker, who presented with an inspiratory stridor was admitted to the hospital. Chest X-rays and CT showed a posterior mediastinal mass with a diameter of 6 cm infiltrating the trachea and esophagus. There were no abnormalities in either the abdomen or the head. Lab tests were within reference values. Bronchoscopic findings disclosed an obstructive tumor growth in the middle third of the trachea. Specimens were taken for histological analysis.

In the submitted tissue samples an invasive solid malignant tumor was observed with focal hemorrhage and necrosis. The tumoral cells were of medium size, epithelioid, with high mitotic activity. Immunohistochemistry was done. Cytokeratins, S100, EMA and TdT were all negative and CD138 was positive, although there was no light chain restriction. She was treated with radiation. 18 months after the initial presentation follow-up revealed that the primary tumor had grown to 10 cm and that there was a new nodule in the lung, which was excised.

Histological examination of the excised lesion showed the same morphology as the primary tumor. Additional immunohistochemistry was performed, showing that the tumor was positive for CD99, vimentin and CD138. Desmin, LCA, smooth muscle actin, CD79a, CD68, CD31, CD34, factor VIII, podoplanin and various epithelial markers (panCK, CK HMW, AE1/AE3, MNF116, CK5, CK7, CK8, CK18, EMA, E- cadherin) were all negative. The patient died less than one year after the initial hospital admission. An autopsy was not performed.

Created date: 2014-04-15