Presentation
1 week of productive cough
Patient Data
Ill-defined opacity superimposed on the anterior right 1st rib. No osseous erosion. Patchy airspace opacities in the right lower zone.
3 cm spiculated mass in the right lung apex with surrounding ground glass opacities and traction bronchiectasis. No osseous erosion.
Bilateral lower lobe consolidation and small pleural effusions in keeping with infection.
Rounded focus of infiltrate superior to the right lower lobe consolidation. This may relate to the adjacent infection or a second malignancy.
Background centrilobular emphysema.
No hilar, mediastinal or supraclavicular lymphadenopathy.
Incidental T11 superior endplate fracture.
Post antibiotics there has been near complete resolution of the lower lobe consolidation and pleural effusions.
Unchanged right apical spiculated mass.
Persistent 1.5 cm posterior right lower lobe lesion with central bubbly lucencies suspicious for a synchronous primary lung cancer.
No lymphadenopathy.
Increased loss of height at the T11 vertebral body fracture.
Case Discussion
Right upper lobe lesion biopsy.
Microscopic description: The tumor is comprised of atypical epithelioid cells arranged in irregularly shaped, variably sized acinar structures with lepidic growth along adjacent alveolar septae. The cells have large, pleomorphic nuclei, prominent eosinophilic nucleoli and intranuclear pseudoinclusions.
TTF1 positive.
P40 negative.
Diagnosis: Moderately differentiated lung adenocarcinoma.
PET scan demonstrated no involved nodes or distant metastases. Mild uptake in the right lower lobe lesion.
Conclusion:
- right upper lobe adenocarcinoma - T1c N0 M0
- likely synchronous right lower lobe primary lung cancer