DOI: 10.1148/rg.263055211
Pleuropulmonary Synovial Sarcoma1
Aletta Ann Frazier, MD,
Teri J. Franks, MD,
Robert D. Pugatch, MD and
Jeffrey R. Galvin, MD
1 From the Departments of Radiologic Pathology (A.A.F., J.R.G.) and Pulmonary and Mediastinal Pathology (T.J.F.), Armed Forces Institute of Pathology, 14th St and Alaska Ave NW, Washington, DC 20306-6000; and the Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Md (A.A.F., R.D.P., J.R.G.). Received December 15, 2005; revision requested January 18, 2006 and received February 15; accepted February 20. All authors have no financial relationships to disclose.
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Figure 1a. PPSS in a 54-year-old woman with a cough. (a) Posteroanterior chest radiograph depicts a left hilar mass. The visibility of hilar structures (arrow) indicates that the mass is not contiguous with the hilum. (b) Contrast-enhanced CT scan depicts a heterogeneous, low-attenuation mass partly surrounded by atelectatic lung tissue (*). (c) Photograph of the gross specimen shows a bosselated mass adherent to the visceral surface (arrows) of atelectatic lung tissue (black asterisk). Lighter-colored normal lung tissue (white asterisk) is visible at the right.
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Figure 1b. PPSS in a 54-year-old woman with a cough. (a) Posteroanterior chest radiograph depicts a left hilar mass. The visibility of hilar structures (arrow) indicates that the mass is not contiguous with the hilum. (b) Contrast-enhanced CT scan depicts a heterogeneous, low-attenuation mass partly surrounded by atelectatic lung tissue (*). (c) Photograph of the gross specimen shows a bosselated mass adherent to the visceral surface (arrows) of atelectatic lung tissue (black asterisk). Lighter-colored normal lung tissue (white asterisk) is visible at the right.
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Figure 1c. PPSS in a 54-year-old woman with a cough. (a) Posteroanterior chest radiograph depicts a left hilar mass. The visibility of hilar structures (arrow) indicates that the mass is not contiguous with the hilum. (b) Contrast-enhanced CT scan depicts a heterogeneous, low-attenuation mass partly surrounded by atelectatic lung tissue (*). (c) Photograph of the gross specimen shows a bosselated mass adherent to the visceral surface (arrows) of atelectatic lung tissue (black asterisk). Lighter-colored normal lung tissue (white asterisk) is visible at the right.
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Figure 2a. PPSS in a 48-year-old woman with a cough. (a) Posteroanterior chest radiograph demonstrates a supra-hilar mass that extends into the right lung. (b) Contrast-enhanced CT scan (lung window) demonstrates a mass, contiguous with the mediastinal pleura, that forms acute angles with the chest wall. (c) Photograph of the gross specimen shows a well-circumscribed multicystic mass that abuts the pleura (curved arrow) and is surrounded by lung tissue. The mass is partly encapsulated and contains extensive areas of hemorrhage (straight arrow) and necrosis (arrowhead), as well as solid tumor tissue (*).
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Figure 2b. PPSS in a 48-year-old woman with a cough. (a) Posteroanterior chest radiograph demonstrates a supra-hilar mass that extends into the right lung. (b) Contrast-enhanced CT scan (lung window) demonstrates a mass, contiguous with the mediastinal pleura, that forms acute angles with the chest wall. (c) Photograph of the gross specimen shows a well-circumscribed multicystic mass that abuts the pleura (curved arrow) and is surrounded by lung tissue. The mass is partly encapsulated and contains extensive areas of hemorrhage (straight arrow) and necrosis (arrowhead), as well as solid tumor tissue (*).
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Figure 2c. PPSS in a 48-year-old woman with a cough. (a) Posteroanterior chest radiograph demonstrates a supra-hilar mass that extends into the right lung. (b) Contrast-enhanced CT scan (lung window) demonstrates a mass, contiguous with the mediastinal pleura, that forms acute angles with the chest wall. (c) Photograph of the gross specimen shows a well-circumscribed multicystic mass that abuts the pleura (curved arrow) and is surrounded by lung tissue. The mass is partly encapsulated and contains extensive areas of hemorrhage (straight arrow) and necrosis (arrowhead), as well as solid tumor tissue (*).
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Figure 3a. PPSS in a 37-year-old-man with chest pain and right arm swelling. (a) Posteroanterior radiograph of the upper chest demonstrates a right apical mass with a chest wall interface suggestive of extrapulmonary origin, and, inferior to the mass, a pleural-based nodule (arrow). (b) Contrast-enhanced CT scan demonstrates a predominantly cystic mass with an eccentrically thickened wall (*) and a metastatic nodule (arrowhead) along the lateral pleural surface. (c) Photograph of the gross specimen shows a unilocular cystic mass, resected en bloc with a section of rib (*). The inner wall of the cyst is lined with irregular masses of pink-tan tumor (arrowheads).
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Figure 3b. PPSS in a 37-year-old-man with chest pain and right arm swelling. (a) Posteroanterior radiograph of the upper chest demonstrates a right apical mass with a chest wall interface suggestive of extrapulmonary origin, and, inferior to the mass, a pleural-based nodule (arrow). (b) Contrast-enhanced CT scan demonstrates a predominantly cystic mass with an eccentrically thickened wall (*) and a metastatic nodule (arrowhead) along the lateral pleural surface. (c) Photograph of the gross specimen shows a unilocular cystic mass, resected en bloc with a section of rib (*). The inner wall of the cyst is lined with irregular masses of pink-tan tumor (arrowheads).
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Figure 3c. PPSS in a 37-year-old-man with chest pain and right arm swelling. (a) Posteroanterior radiograph of the upper chest demonstrates a right apical mass with a chest wall interface suggestive of extrapulmonary origin, and, inferior to the mass, a pleural-based nodule (arrow). (b) Contrast-enhanced CT scan demonstrates a predominantly cystic mass with an eccentrically thickened wall (*) and a metastatic nodule (arrowhead) along the lateral pleural surface. (c) Photograph of the gross specimen shows a unilocular cystic mass, resected en bloc with a section of rib (*). The inner wall of the cyst is lined with irregular masses of pink-tan tumor (arrowheads).
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Figure 4a. PPSS in a 36-year-old man with dyspnea and pleuritic chest pain. (a) Posteroanterior chest radiograph of the right lung demonstrates a right hilar mass with smooth borders. (b) Contrast-enhanced CT scan demonstrates a large, low-attenuation mass with an enhanced rim (arrowhead) and internal septa. (c) Axial unenhanced T1-weighted (repetition time msec/echo time msec, 516.7/10) MR image demonstrates marked heterogeneity not evident in b. (d) Axial T2-weighted (2110/57.6) MR image shows further contrast among internal components, with well-demarcated spaces (arrowheads) suggestive of cysts. (e) Axial gadolinium-enhanced T1-weighted (28/1.4) MR image demonstrates nodular areas of increased blood flow represented by increased signal intensity (*) compared with that in c. Enhancement of the rim (arrowhead) also is evident. (f) Photograph of the gross specimen demonstrates a well-circumscribed, partly encapsulated (straight arrow) reniform mass attached to the chest wall (curved arrow) and surrounded by lung tissue (black asterisk). Cut surface reveals marked variability of contents, with collapsed cysts (white asterisks), zones of necrosis, areas of hemorrhage, and solid tumor tissue (arrowhead).
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Figure 4b. PPSS in a 36-year-old man with dyspnea and pleuritic chest pain. (a) Posteroanterior chest radiograph of the right lung demonstrates a right hilar mass with smooth borders. (b) Contrast-enhanced CT scan demonstrates a large, low-attenuation mass with an enhanced rim (arrowhead) and internal septa. (c) Axial unenhanced T1-weighted (repetition time msec/echo time msec, 516.7/10) MR image demonstrates marked heterogeneity not evident in b. (d) Axial T2-weighted (2110/57.6) MR image shows further contrast among internal components, with well-demarcated spaces (arrowheads) suggestive of cysts. (e) Axial gadolinium-enhanced T1-weighted (28/1.4) MR image demonstrates nodular areas of increased blood flow represented by increased signal intensity (*) compared with that in c. Enhancement of the rim (arrowhead) also is evident. (f) Photograph of the gross specimen demonstrates a well-circumscribed, partly encapsulated (straight arrow) reniform mass attached to the chest wall (curved arrow) and surrounded by lung tissue (black asterisk). Cut surface reveals marked variability of contents, with collapsed cysts (white asterisks), zones of necrosis, areas of hemorrhage, and solid tumor tissue (arrowhead).
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Figure 4c. PPSS in a 36-year-old man with dyspnea and pleuritic chest pain. (a) Posteroanterior chest radiograph of the right lung demonstrates a right hilar mass with smooth borders. (b) Contrast-enhanced CT scan demonstrates a large, low-attenuation mass with an enhanced rim (arrowhead) and internal septa. (c) Axial unenhanced T1-weighted (repetition time msec/echo time msec, 516.7/10) MR image demonstrates marked heterogeneity not evident in b. (d) Axial T2-weighted (2110/57.6) MR image shows further contrast among internal components, with well-demarcated spaces (arrowheads) suggestive of cysts. (e) Axial gadolinium-enhanced T1-weighted (28/1.4) MR image demonstrates nodular areas of increased blood flow represented by increased signal intensity (*) compared with that in c. Enhancement of the rim (arrowhead) also is evident. (f) Photograph of the gross specimen demonstrates a well-circumscribed, partly encapsulated (straight arrow) reniform mass attached to the chest wall (curved arrow) and surrounded by lung tissue (black asterisk). Cut surface reveals marked variability of contents, with collapsed cysts (white asterisks), zones of necrosis, areas of hemorrhage, and solid tumor tissue (arrowhead).
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Figure 4d. PPSS in a 36-year-old man with dyspnea and pleuritic chest pain. (a) Posteroanterior chest radiograph of the right lung demonstrates a right hilar mass with smooth borders. (b) Contrast-enhanced CT scan demonstrates a large, low-attenuation mass with an enhanced rim (arrowhead) and internal septa. (c) Axial unenhanced T1-weighted (repetition time msec/echo time msec, 516.7/10) MR image demonstrates marked heterogeneity not evident in b. (d) Axial T2-weighted (2110/57.6) MR image shows further contrast among internal components, with well-demarcated spaces (arrowheads) suggestive of cysts. (e) Axial gadolinium-enhanced T1-weighted (28/1.4) MR image demonstrates nodular areas of increased blood flow represented by increased signal intensity (*) compared with that in c. Enhancement of the rim (arrowhead) also is evident. (f) Photograph of the gross specimen demonstrates a well-circumscribed, partly encapsulated (straight arrow) reniform mass attached to the chest wall (curved arrow) and surrounded by lung tissue (black asterisk). Cut surface reveals marked variability of contents, with collapsed cysts (white asterisks), zones of necrosis, areas of hemorrhage, and solid tumor tissue (arrowhead).
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Figure 4e. PPSS in a 36-year-old man with dyspnea and pleuritic chest pain. (a) Posteroanterior chest radiograph of the right lung demonstrates a right hilar mass with smooth borders. (b) Contrast-enhanced CT scan demonstrates a large, low-attenuation mass with an enhanced rim (arrowhead) and internal septa. (c) Axial unenhanced T1-weighted (repetition time msec/echo time msec, 516.7/10) MR image demonstrates marked heterogeneity not evident in b. (d) Axial T2-weighted (2110/57.6) MR image shows further contrast among internal components, with well-demarcated spaces (arrowheads) suggestive of cysts. (e) Axial gadolinium-enhanced T1-weighted (28/1.4) MR image demonstrates nodular areas of increased blood flow represented by increased signal intensity (*) compared with that in c. Enhancement of the rim (arrowhead) also is evident. (f) Photograph of the gross specimen demonstrates a well-circumscribed, partly encapsulated (straight arrow) reniform mass attached to the chest wall (curved arrow) and surrounded by lung tissue (black asterisk). Cut surface reveals marked variability of contents, with collapsed cysts (white asterisks), zones of necrosis, areas of hemorrhage, and solid tumor tissue (arrowhead).
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Figure 4f. PPSS in a 36-year-old man with dyspnea and pleuritic chest pain. (a) Posteroanterior chest radiograph of the right lung demonstrates a right hilar mass with smooth borders. (b) Contrast-enhanced CT scan demonstrates a large, low-attenuation mass with an enhanced rim (arrowhead) and internal septa. (c) Axial unenhanced T1-weighted (repetition time msec/echo time msec, 516.7/10) MR image demonstrates marked heterogeneity not evident in b. (d) Axial T2-weighted (2110/57.6) MR image shows further contrast among internal components, with well-demarcated spaces (arrowheads) suggestive of cysts. (e) Axial gadolinium-enhanced T1-weighted (28/1.4) MR image demonstrates nodular areas of increased blood flow represented by increased signal intensity (*) compared with that in c. Enhancement of the rim (arrowhead) also is evident. (f) Photograph of the gross specimen demonstrates a well-circumscribed, partly encapsulated (straight arrow) reniform mass attached to the chest wall (curved arrow) and surrounded by lung tissue (black asterisk). Cut surface reveals marked variability of contents, with collapsed cysts (white asterisks), zones of necrosis, areas of hemorrhage, and solid tumor tissue (arrowhead).
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Figure 5a. PPSS in a 29-year-old man with pleuritic pain. (a) Posteroanterior chest radiograph of the left lung demonstrates a suprahilar mass with smooth borders. (b) Contrast-enhanced CT scan shows a homogeneous mass that abuts the left main pulmonary artery. (c) Axial T2-weighted (2666/90.8) MR image depicts a mass with mild heterogeneity, signal intensity slightly higher than that of muscle, and a rim of higher signal intensity that conforms to the major fissure (arrowhead). (d) Axial gadolinium-enhanced T1-weighted (150/4.2) MR image demonstrates a curvilinear peripheral area of striking enhancement (arrow) that correlates with the capsule. (e) Photograph of the gross specimen shows a well-circumscribed mass partly surrounded by a fibrous capsule (curved arrow). Cut surface reveals variable contents including cysts, some of which contain blood (*). Areas of solid tumor vary in color from yellow-tan to pink and contain foci of hemorrhage (arrowhead) and necrosis (straight arrow). The surrounding lung tissue is inked black. (f) Low-power photomicrograph (original magnification, x100; H-E stain) reveals a bandlike arrangement of vascular spaces (arrowheads) at the interface of the capsule (curved arrow) and viable tumor (straight arrow); tumor necrosis also is present (*).
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Figure 5b. PPSS in a 29-year-old man with pleuritic pain. (a) Posteroanterior chest radiograph of the left lung demonstrates a suprahilar mass with smooth borders. (b) Contrast-enhanced CT scan shows a homogeneous mass that abuts the left main pulmonary artery. (c) Axial T2-weighted (2666/90.8) MR image depicts a mass with mild heterogeneity, signal intensity slightly higher than that of muscle, and a rim of higher signal intensity that conforms to the major fissure (arrowhead). (d) Axial gadolinium-enhanced T1-weighted (150/4.2) MR image demonstrates a curvilinear peripheral area of striking enhancement (arrow) that correlates with the capsule. (e) Photograph of the gross specimen shows a well-circumscribed mass partly surrounded by a fibrous capsule (curved arrow). Cut surface reveals variable contents including cysts, some of which contain blood (*). Areas of solid tumor vary in color from yellow-tan to pink and contain foci of hemorrhage (arrowhead) and necrosis (straight arrow). The surrounding lung tissue is inked black. (f) Low-power photomicrograph (original magnification, x100; H-E stain) reveals a bandlike arrangement of vascular spaces (arrowheads) at the interface of the capsule (curved arrow) and viable tumor (straight arrow); tumor necrosis also is present (*).
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Figure 5c. PPSS in a 29-year-old man with pleuritic pain. (a) Posteroanterior chest radiograph of the left lung demonstrates a suprahilar mass with smooth borders. (b) Contrast-enhanced CT scan shows a homogeneous mass that abuts the left main pulmonary artery. (c) Axial T2-weighted (2666/90.8) MR image depicts a mass with mild heterogeneity, signal intensity slightly higher than that of muscle, and a rim of higher signal intensity that conforms to the major fissure (arrowhead). (d) Axial gadolinium-enhanced T1-weighted (150/4.2) MR image demonstrates a curvilinear peripheral area of striking enhancement (arrow) that correlates with the capsule. (e) Photograph of the gross specimen shows a well-circumscribed mass partly surrounded by a fibrous capsule (curved arrow). Cut surface reveals variable contents including cysts, some of which contain blood (*). Areas of solid tumor vary in color from yellow-tan to pink and contain foci of hemorrhage (arrowhead) and necrosis (straight arrow). The surrounding lung tissue is inked black. (f) Low-power photomicrograph (original magnification, x100; H-E stain) reveals a bandlike arrangement of vascular spaces (arrowheads) at the interface of the capsule (curved arrow) and viable tumor (straight arrow); tumor necrosis also is present (*).
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Figure 5d. PPSS in a 29-year-old man with pleuritic pain. (a) Posteroanterior chest radiograph of the left lung demonstrates a suprahilar mass with smooth borders. (b) Contrast-enhanced CT scan shows a homogeneous mass that abuts the left main pulmonary artery. (c) Axial T2-weighted (2666/90.8) MR image depicts a mass with mild heterogeneity, signal intensity slightly higher than that of muscle, and a rim of higher signal intensity that conforms to the major fissure (arrowhead). (d) Axial gadolinium-enhanced T1-weighted (150/4.2) MR image demonstrates a curvilinear peripheral area of striking enhancement (arrow) that correlates with the capsule. (e) Photograph of the gross specimen shows a well-circumscribed mass partly surrounded by a fibrous capsule (curved arrow). Cut surface reveals variable contents including cysts, some of which contain blood (*). Areas of solid tumor vary in color from yellow-tan to pink and contain foci of hemorrhage (arrowhead) and necrosis (straight arrow). The surrounding lung tissue is inked black. (f) Low-power photomicrograph (original magnification, x100; H-E stain) reveals a bandlike arrangement of vascular spaces (arrowheads) at the interface of the capsule (curved arrow) and viable tumor (straight arrow); tumor necrosis also is present (*).
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Figure 5e. PPSS in a 29-year-old man with pleuritic pain. (a) Posteroanterior chest radiograph of the left lung demonstrates a suprahilar mass with smooth borders. (b) Contrast-enhanced CT scan shows a homogeneous mass that abuts the left main pulmonary artery. (c) Axial T2-weighted (2666/90.8) MR image depicts a mass with mild heterogeneity, signal intensity slightly higher than that of muscle, and a rim of higher signal intensity that conforms to the major fissure (arrowhead). (d) Axial gadolinium-enhanced T1-weighted (150/4.2) MR image demonstrates a curvilinear peripheral area of striking enhancement (arrow) that correlates with the capsule. (e) Photograph of the gross specimen shows a well-circumscribed mass partly surrounded by a fibrous capsule (curved arrow). Cut surface reveals variable contents including cysts, some of which contain blood (*). Areas of solid tumor vary in color from yellow-tan to pink and contain foci of hemorrhage (arrowhead) and necrosis (straight arrow). The surrounding lung tissue is inked black. (f) Low-power photomicrograph (original magnification, x100; H-E stain) reveals a bandlike arrangement of vascular spaces (arrowheads) at the interface of the capsule (curved arrow) and viable tumor (straight arrow); tumor necrosis also is present (*).
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Figure 5f. PPSS in a 29-year-old man with pleuritic pain. (a) Posteroanterior chest radiograph of the left lung demonstrates a suprahilar mass with smooth borders. (b) Contrast-enhanced CT scan shows a homogeneous mass that abuts the left main pulmonary artery. (c) Axial T2-weighted (2666/90.8) MR image depicts a mass with mild heterogeneity, signal intensity slightly higher than that of muscle, and a rim of higher signal intensity that conforms to the major fissure (arrowhead). (d) Axial gadolinium-enhanced T1-weighted (150/4.2) MR image demonstrates a curvilinear peripheral area of striking enhancement (arrow) that correlates with the capsule. (e) Photograph of the gross specimen shows a well-circumscribed mass partly surrounded by a fibrous capsule (curved arrow). Cut surface reveals variable contents including cysts, some of which contain blood (*). Areas of solid tumor vary in color from yellow-tan to pink and contain foci of hemorrhage (arrowhead) and necrosis (straight arrow). The surrounding lung tissue is inked black. (f) Low-power photomicrograph (original magnification, x100; H-E stain) reveals a bandlike arrangement of vascular spaces (arrowheads) at the interface of the capsule (curved arrow) and viable tumor (straight arrow); tumor necrosis also is present (*).
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Figure 6a. PPSS in a 42-year-old woman with dyspnea. (a) Posteroanterior chest radiograph demonstrates an opacified left hemithorax with rightward shift of the mediastinum. (b) Coronal CT image reconstructed from axial CT data shows a large heterogeneous mass (*) that fills the upper left hemithorax; a large pleural effusion; and a pleural-based metastasis on the diaphragmatic surface (arrow).
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Figure 6b. PPSS in a 42-year-old woman with dyspnea. (a) Posteroanterior chest radiograph demonstrates an opacified left hemithorax with rightward shift of the mediastinum. (b) Coronal CT image reconstructed from axial CT data shows a large heterogeneous mass (*) that fills the upper left hemithorax; a large pleural effusion; and a pleural-based metastasis on the diaphragmatic surface (arrow).
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Figure 7a. PPSS in a 21-year-old man with right-sided chest pain. (a) Contrast-enhanced CT scan demonstrates a multilobular, heterogeneous, pleural-based mass. (b) Photograph of the gross specimen demonstrates a bosselated solid tan mass that is partly encapsulated and that adheres to an adjacent rib (*). (c) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of eosinophilic protein-aceous cyst contents (*) and viable tumor cells. (d) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of zones of myxoid change (*) and tumor cells (arrowhead), with more prominent vascularity (arrow) in the latter. (e) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface (arrowheads) between fascicles of tumor cells (*) oriented in different planes. These distinct tissue interfaces offer a possible explanation for the heterogeneous imaging features.
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Figure 7b. PPSS in a 21-year-old man with right-sided chest pain. (a) Contrast-enhanced CT scan demonstrates a multilobular, heterogeneous, pleural-based mass. (b) Photograph of the gross specimen demonstrates a bosselated solid tan mass that is partly encapsulated and that adheres to an adjacent rib (*). (c) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of eosinophilic protein-aceous cyst contents (*) and viable tumor cells. (d) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of zones of myxoid change (*) and tumor cells (arrowhead), with more prominent vascularity (arrow) in the latter. (e) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface (arrowheads) between fascicles of tumor cells (*) oriented in different planes. These distinct tissue interfaces offer a possible explanation for the heterogeneous imaging features.
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Figure 7c. PPSS in a 21-year-old man with right-sided chest pain. (a) Contrast-enhanced CT scan demonstrates a multilobular, heterogeneous, pleural-based mass. (b) Photograph of the gross specimen demonstrates a bosselated solid tan mass that is partly encapsulated and that adheres to an adjacent rib (*). (c) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of eosinophilic protein-aceous cyst contents (*) and viable tumor cells. (d) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of zones of myxoid change (*) and tumor cells (arrowhead), with more prominent vascularity (arrow) in the latter. (e) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface (arrowheads) between fascicles of tumor cells (*) oriented in different planes. These distinct tissue interfaces offer a possible explanation for the heterogeneous imaging features.
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Figure 7d. PPSS in a 21-year-old man with right-sided chest pain. (a) Contrast-enhanced CT scan demonstrates a multilobular, heterogeneous, pleural-based mass. (b) Photograph of the gross specimen demonstrates a bosselated solid tan mass that is partly encapsulated and that adheres to an adjacent rib (*). (c) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of eosinophilic protein-aceous cyst contents (*) and viable tumor cells. (d) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of zones of myxoid change (*) and tumor cells (arrowhead), with more prominent vascularity (arrow) in the latter. (e) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface (arrowheads) between fascicles of tumor cells (*) oriented in different planes. These distinct tissue interfaces offer a possible explanation for the heterogeneous imaging features.
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Figure 7e. PPSS in a 21-year-old man with right-sided chest pain. (a) Contrast-enhanced CT scan demonstrates a multilobular, heterogeneous, pleural-based mass. (b) Photograph of the gross specimen demonstrates a bosselated solid tan mass that is partly encapsulated and that adheres to an adjacent rib (*). (c) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of eosinophilic protein-aceous cyst contents (*) and viable tumor cells. (d) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface of zones of myxoid change (*) and tumor cells (arrowhead), with more prominent vascularity (arrow) in the latter. (e) Low-power photomicrograph (original magnification, x100; H-E stain) shows an interface (arrowheads) between fascicles of tumor cells (*) oriented in different planes. These distinct tissue interfaces offer a possible explanation for the heterogeneous imaging features.
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Figure 8a. PPSS in a 46-year-old woman with right shoulder pain. (a) Contrast-enhanced CT scan demonstrates a homogeneous pleural-based mass and a small pleural effusion. (b) Axial T2-weighted (2379/92.5) MR image shows the same mass with predominantly intermediate signal intensity and high-signal-intensity foci. The pleural effusion also demonstrates high signal intensity. (c) Axial gadolinium-enhanced T1-weighted (140/4.2) MR image shows an enhanced rim (arrowhead).
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Figure 8b. PPSS in a 46-year-old woman with right shoulder pain. (a) Contrast-enhanced CT scan demonstrates a homogeneous pleural-based mass and a small pleural effusion. (b) Axial T2-weighted (2379/92.5) MR image shows the same mass with predominantly intermediate signal intensity and high-signal-intensity foci. The pleural effusion also demonstrates high signal intensity. (c) Axial gadolinium-enhanced T1-weighted (140/4.2) MR image shows an enhanced rim (arrowhead).
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Figure 8c. PPSS in a 46-year-old woman with right shoulder pain. (a) Contrast-enhanced CT scan demonstrates a homogeneous pleural-based mass and a small pleural effusion. (b) Axial T2-weighted (2379/92.5) MR image shows the same mass with predominantly intermediate signal intensity and high-signal-intensity foci. The pleural effusion also demonstrates high signal intensity. (c) Axial gadolinium-enhanced T1-weighted (140/4.2) MR image shows an enhanced rim (arrowhead).
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Figure 9a. PPSS in a 27-year-old woman with a recent onset of dyspnea. (a) Contrast-enhanced CT scan depicts marked heterogeneity, with enhanced linear structures consistent with vessels (arrowheads) and surrounding collapsed lung (*). (b) Axial PET/CT fusion image shows increased FDG uptake in the mass, with a maximum standardized uptake value of 7.0. (c) Photograph of the gross specimen shows a well-circumscribed encapsulated mass bordered by lung tissue (*). The cut surface is variegated tan-white with focal areas of hemorrhage (arrow) and prominent vessels (arrowhead).
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Figure 9b. PPSS in a 27-year-old woman with a recent onset of dyspnea. (a) Contrast-enhanced CT scan depicts marked heterogeneity, with enhanced linear structures consistent with vessels (arrowheads) and surrounding collapsed lung (*). (b) Axial PET/CT fusion image shows increased FDG uptake in the mass, with a maximum standardized uptake value of 7.0. (c) Photograph of the gross specimen shows a well-circumscribed encapsulated mass bordered by lung tissue (*). The cut surface is variegated tan-white with focal areas of hemorrhage (arrow) and prominent vessels (arrowhead).
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Figure 9c. PPSS in a 27-year-old woman with a recent onset of dyspnea. (a) Contrast-enhanced CT scan depicts marked heterogeneity, with enhanced linear structures consistent with vessels (arrowheads) and surrounding collapsed lung (*). (b) Axial PET/CT fusion image shows increased FDG uptake in the mass, with a maximum standardized uptake value of 7.0. (c) Photograph of the gross specimen shows a well-circumscribed encapsulated mass bordered by lung tissue (*). The cut surface is variegated tan-white with focal areas of hemorrhage (arrow) and prominent vessels (arrowhead).
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Figure 10. Unencapsulated PPSS. Low-power photomicrograph (original magnification, x100; H-E stain) shows a tumor (*) with a well-demarcated expansile border (arrowheads) that mildly compresses adjacent alveoli. There is no capsule between the tumor and lung tissue.
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Figure 11. Encapsulated PPSS. Medium-power photomicrograph (original magnification, x200; H-E stain) shows a thick fibrous capsule (between arrowheads) that borders viable tumor tissue (*).
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Figure 12. Heterogeneity of PPSS. Low-power photomicrograph (original magnification, x 100; H-E stain) shows areas of myxoid change (curved arrow), densely cellular tumor tissue (straight arrow), cystic spaces (*), and hemorrhage with necrosis (arrowhead).
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Figure 13. Monophasic PPSS. Medium-power photomicrograph (original magnification, x200; H-E stain) demonstrates intertwining fascicles of densely packed spindle cells.
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Figure 14. Biphasic PPSS. High-power photomicrograph (original magnification, x400; H-E stain) demonstrates the epithelial (left) and spindle cell (right) components characteristic of this tumor.
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Copyright © 2006 by the Radiological Society of North America.
