Primary pulmonary MPNST?A rare case report

A 60 years old smoker, normotensive, non‒diabetic presented with chief complaints of cough, fever and weight loss for 20 days. On examination the patient was conscious, co‒operative, well oriented, with a respiratory rate of 18/min, blood pressure of 120/70 and pulse rate of 86/min. Cardiovascular and per‒abdomen examination were clinically normal. However, on auscultation decreased breath sounds were found on left lower side of chest. Chest radiograph revealed a lesion in the left lung. CT scan (contrast enhanced) of chest was done which showed a 71x59mm cystic lesion in the superior segment of left lower lobe. Cyst showed internal septations without calcification. USG abdomen and PFT (pulmonary function tests) were normal. Hydrated serology was negative and not suggestive. Routine complete blood counts, LFT (liver function test) and KFT (kidney function tests), were within normal limits. The patient underwent left postero‒lateral thoracotomy with lower lobe lobectomy. Intra‒operatively there was large bronchogenic mass occupying almost whole of the left lobe with multiple hilar nodes. On gross examination, we received a lobe of lung measuring 15x9.5x5cm. Serial slicing of the lung showed a well circumscribed mass measuring 7x8cm. Cut section showed variegated appearance with extensive hemorrhagic and necrotic areas. On light microscopy a spindle cell tumour was seen with cells having moderate to severe pleomorphism and mitosis of >10/10hpf, and extensive areas of necrosis (Figure 1a) (Figure 1b).