Figure 2.

A 45-year-old male patient with a known previously diagnosed non-seminomatous germ cell tumor and multiple pulmonary nodules on (A) computed tomography (arrow) and (B,C) B-mode ultrasound. An ultrasound-guided 18 G core needle biopsy of the lung lesion was performed, and histopathological examination confirmed the diagnosis of a metastatic germ cell tumor. On contrast-enhanced ultrasound, the lesion displayed (D) early enhancement, indicative of a pulmonary-arterial supply, and (D) a marked and homogeneous pattern of enhancement with (E,F) an early decrease of enhancement. (G) The tissue sample (HE staining) showed infiltration by a malignant, epithelial differentiated tumor. (H) Immunohistochemical staining with CD34 was performed, revealing a chaotic pattern, consistent with bronchial arterial neoangiogenesis (×200).