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AP chest radiograph.
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Chest X-ray was done immediately, which showed a picture of emphysematous lesion versus a large multiloculated cystic mass in the hemithorax, displacing the heart and mediastinum to the left side indicating a possibility of pneumothorax; hence, an intercostal drain (ICD) was inserted for this high possibility (Fig. 1).
Axial CT cuts of the chest.
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Part of normal appearing right lung is seen anterior to the heart (Fig. 2).
Cystic lesion.
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Intraoperatively, a large multilobulated cystic lesion was found occupying the whole right hemithorax (Figs. 3, 4).
Resected right lower lobe.
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Intraoperatively, a large multilobulated cystic lesion was found occupying the whole right hemithorax (Figs. 3, 4).
H&E: x200 The resected lung.
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The normal lung parenchyma is replaced by cysts that are lined by focally hyperplastic columnar epithelium and the lung parenchyma is replaced by medium-sized blue cells (Fig. 5).
H&E: x100. The pleura.
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The mesenchymal cells are positive for desmin and smooth muscle actin (SMA) (Fig. 6).
Six-month follow-up CT.
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CT showed a spiculated soft tissue nodule at the medial basal segment at operative resection site. Concern was raised about the possibility of recurrent tumor (Fig. 7).
Two-year follow-up.
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