PMC9790769_01
Chest computed tomography (CT) scans (A-D) demonstrating multiple lung nodules with different CT densities. A left upper lung nodule (A, red arrowhead) showed a low CT density [35-50 Hounsfield units (HU)], but the right and left lower lung nodules (B, yellow arrows) had high CT densities of 98-114 HU, which were compatible with high-attenuation mucoid (HAM) impactions. Chest 18F-fluorodeoxyglucose (FDG)-positron emission tomography revealed an increased FDG uptake in the left upper lung nodule (E, red arrowhead), showing a standardized maximum uptake value (SUVmax) of 5.9, which was higher than the SUVmax of 1.4 of the HAM impaction in the left lower lobe (F, yellow arrow), suggesting that the nodules had different properties.
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A lung nodule in the apex of the left upper lobe showed a lower CT density [35-50 Hounsfield units (HU)] than many other HAM impactions, which showed relatively high CT densities (98-114 HU (Fig. 1). The FDG uptake by the left upper lung nodule (Fig. 1E), with a standardized maximum uptake value (SUVmax) of 5.9, was higher than the HAM impaction in the left lower lobe, with an SUVmax of 1.4 (Fig. 1F).
A transbronchial lung biopsy specimen from the left upper lung nodule revealed adenocarcinoma [Hematoxylin and Eosin (H&E) staining, A]. H&E staining (B) and immunohistochemical staining of carcinoembryonic antigen (CEA) (C) of the surgically resected left upper lung lobe revealed that adenocarcinoma was positively stained with CEA. Original magnification x200.
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A transbronchial lung biopsy specimen and cytological examination of the left upper lung nodule provided evidence of lung adenocarcinoma (Fig. 2). IIIA (pT2aN2M0) papillary adenocarcinoma with an exon 19 deletion of the epidermal growth factor receptor gene. Immunohistochemistry of lung adenocarcinoma in the left upper lobe obtained by surgical resection revealed that the tumor was positive for CEA staining (Fig. 2C).
Chest computed tomography (CT) before (A) and after (B, C) treatment of lung cancer showing the disappearance of high-attenuation mucoid (HAM) impactions (red arrows) and the presence of central bronchiectasis (yellow arrows).
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The patient has been free from recurrence of the lung cancer, and the HAM impactions have been gone for more than 4.5 years, with her serum levels of CEA decreasing to <13.8 ng/mL (Fig. 3, 4).
Sequential changes in serum carcinoembryonic antigen (CEA) levels before and after surgical resection of the lung adenocarcinoma in the left upper lobe. Serum CEA levels were dramatically decreased after resection of the lung tumor and 4 subsequent cycles of adjuvant chemotherapy, for which dexamethasone (6.6 mg) was administered on Day 1 for premedication, in accordance with disappearance of the high-attenuation mucoid (HAM) impactions.
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The patient has been free from recurrence of the lung cancer, and the HAM impactions have been gone for more than 4.5 years, with her serum levels of CEA decreasing to <13.8 ng/mL (Fig. 3, 4).