Pulmonary artery intimal sarcoma in TB-endemic region: A diagnostic challenge

Figures

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  Fig. 1. Chest radiograph (posteroanterior view); A, The patient's initial chest radiograph, obtained at a private hospital, revealed multifocal patchy opacities in the right lung, most prominent in the right lower zone (red arrow), along with blunting of the right costophrenic angle; B, A follow-up chest radiograph, performed after 11 days of empirical antibiotic therapy, demonstrated interval improvement with decreased opacities in the right lower lung field and restoration of a sharp right costophrenic angle; C, At the time of presentation to our center, approximately one month after the initial imaging (Figure A), a repeat chest radiograph showed persistent multifocal patchy opacities in the right lung and mild blunting of the right costophrenic angle, along with prominent right hilar enlargement and increased cardiac size, raising suspicion for pulmonary arterial pathology.

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  Fig. 2. Computed tomography of the chest with contrast (axial view); D, The mediastinal window demonstrates a heterogeneously enhancing lobulated mass (asterisk) within the lumen of the pulmonary artery. The mass completely occludes the pulmonary trunk and obscures the arterial wall, consistent with the wall eclipsing sign (black arrow), a characteristic imaging feature of pulmonary artery sarcoma.; E, The mediastinal window demonstrates multiple subpleural nodules (white arrows), suggestive of pleural metastases.c.

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  Fig. 3. Endobronchial ultrasound (EBUS) image reveals a heterogeneous, hyperechoic mass measuring 29.4 mm (blue asterisk) and 35.9 mm (red asterisk), located adjacent to the pulmonary artery.

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  Fig. 4. Pathology of the tumor: A, Hematoxylin and eosin stain showing undifferentiated tumor composed of epithelioid to plump spindle and pleomorphic cells (x600 magnification); B, Immunohistochemical (IHC) staining for MDM2 showing focal positivity (x600); C, IHC staining for TLE1 showing diffuse positivity (x600); D, IHC staining for smooth muscle actin (SMA) showing focal positivity (x600).