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Clinical question
The patient was a 54-year-old man with symptoms of chronic obstructive pulmonary disease (COPD) who had smoked for many years. A thoracic CT showed bilateral bullae and a tumour measuring 35×25 mm in the right upper lobe (figure 1). Radiological features were consistent with an intraparenchymatous lung tumour. A right upper lobectomy was performed. Gross examination of the surgically excised specimen revealed a nodular lesion measuring 5×5 cm in diameter.
(A) CT scan showing bilateral bullae and a tumour in the right upper lobe. (B) Microscopic appearance showing epithelioid cells filling alveolar spaces and heavy interstitial lymphocytic infiltrate (H&E ×100). (C) Alveolar spaces containing epithelioid cells mixed with lymphocytes (H&E ×200). (D) Atypical epithelioid atypical cells showing round nuclei and large eosinophilic cytoplasms mimicking desquamative pneumonitis (H&E ×400). (E) Epithelioid cells filling pre-existing air spaces lined by TTF-1 positive epithelium (TTF-1 stain …
Footnotes
Handling editor Iskander Chaudhry.
Contributors JL prepared the manuscript and diagnosed the case. AG provided critical clinical information.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
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