{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:47:37Z","timestamp":1788871657731,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,6,23]],"date-time":"2023-06-23T00:00:00Z","timestamp":1687478400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["pericles.pericles-gcp.literatumonline.com"],"crossmark-restriction":true},"short-container-title":["Diagnostic Cytopathology"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Thoracic SMARCA4\u2010deficient undifferentiated tumor (SMARCA4\u2010UT) is a rare entity that was recently described in the current World Health Organization Classification of Tumors. These lesions are highly aggressive with dismal prognosis, and most patients present with metastasis at the time of diagnosis. While there are about 100 cases of SMARCA4\u2010UT described in the literature, there are only few existing reports that describe the cytomorphology of these lesions. We present a patient with masses involving the mediastinum, right lung, right supraclavicular lymph node and right adrenal gland. Subsequent core\u2010needle biopsy of the right supraclavicular lymph node showed epithelioid to pleomorphic tumor cells with prominent nucleoli and associated granulomatous inflammation. The tumor cells were positive for CD34 and synaptophysin, and were negative for cytokeratins. SMARCA4 and SMARCA2 both showed loss of expression, which led to the diagnosis of SMARCA4\u2010UT. The patient underwent treatment with pembrolizumab (PD\u20101 blocker), carboplatin, etoposide, and radiotherapy, resulting in an almost 55% reduction in the size of the primary tumor. Our case illustrates that an associated granulomatous inflammation might be an uncommon presentation of an already rare malignancy, and awareness of this phenomenon would prevent from mistaking SMARCA4\u2010UT for other more well\u2010known entities that can present with granulomas.<\/jats:p>","DOI":"10.1002\/dc.25190","type":"journal-article","created":{"date-parts":[[2023,6,25]],"date-time":"2023-06-25T00:29:51Z","timestamp":1687652991000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Thoracic <scp>SMARCA4\u2010deficient<\/scp> undifferentiated tumor with associated granulomatous reaction and response to pembrolizumab"],"prefix":"10.1002","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2153-6843","authenticated-orcid":false,"given":"Mason","family":"Marshall","sequence":"first","affiliation":[{"name":"Department of Pathology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5670-6254","authenticated-orcid":false,"given":"Samer","family":"Khader","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7333-3661","authenticated-orcid":false,"given":"Scott","family":"Beasley","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2828-532X","authenticated-orcid":false,"given":"Sigfred","family":"Lajara","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,23]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"WHO Classification of Tumours Editorial Board. Thoracic Tumours. International Agency for Research on Cancer","author":"Yoshida A, Boland JM, Le Loarer F, Jain D, Rekhtman N","year":"2021"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000510323"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng.3399"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001188"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2017.11"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2017.61"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2019.10.023"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1066896919865944"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1066896919870866"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000493335"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqab101"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.21037\/med-20-15"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2017.05.024"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2019.05.011"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-020-03011-3"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12672-023-00639-w"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1158\/1535-7163.MCT-21-0433"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2559.1996.t01-2-297345.x"},{"issue":"7","key":"e_1_2_6_20_1","first-page":"2772","article-title":"Hodgkin's lymphoma with marked granulomatous reaction: a diagnostic pitfall","volume":"12","author":"Du J","year":"2019","journal-title":"Int J Clin Exp Pathol"},{"issue":"4","key":"e_1_2_6_21_1","first-page":"353","article-title":"Granulomatous nasopharyngeal carcinoma: with emphasis on difficulty in diagnosis and favorable outcome","volume":"90","author":"Chen CL","year":"1991","journal-title":"J Formos Med Assoc"},{"key":"e_1_2_6_22_1","first-page":"369","volume-title":"Cytology: Diagnostic Principles and Clinical Correlates","author":"Cibas E","year":"2014"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21532"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00125480-199801000-00001"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.4103\/0377-4929.188113"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.01.94"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtocrr.2023.100494"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/1759-7714.14547"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz160"}],"container-title":["Diagnostic Cytopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.25190","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T15:28:24Z","timestamp":1693927704000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/dc.25190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,23]]},"references-count":28,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1002\/dc.25190"],"URL":"https:\/\/doi.org\/10.1002\/dc.25190","archive":["Portico"],"relation":{},"ISSN":["8755-1039","1097-0339"],"issn-type":[{"value":"8755-1039","type":"print"},{"value":"1097-0339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,23]]},"assertion":[{"value":"2023-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}