PMC7657689_01
Winging of scapula. (a) Winging of the right scapula posteriorly (lateral view). (b) Winging of the right scapula (posterior view).
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Posterior winging of the right scapula was noted, which became more prominent up on pushing against resistance (Figures 1(a) and 1(b)).
Chest radiograph:posterior-anterior view:right side apical ill-defined mass causing tracheal deviation to opposite side.
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The chest radiograph revealed a large homogenous opacity involving the right apical region (Figure 2).
CECT chest:ill-defined enhancing malignant lesion:obliterating the right upper bronchus, right upper lobe, pulmonary artery, and pleura.
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Subsequent contrast-enhanced computerized tomography (CECT) showed an ill-defined enhancing malignant lesion, obliterating the right upper bronchus, right upper lobe, pulmonary artery, and pleura (Figure 3).
Immunohistochemistry of lymph node biopsy is positive for thyroid transcription factor 1 (TTF-1) confirming metastasis from an adenocarcinoma of lung.
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Histology and immunohistochemistry (Figure 4) of a cervical lymph node revealed metastatic deposits from a poorly differentiated carcinoma, most probably of pulmonary origin.
Histology of the biopsy taken from:endobronchial tumor at bronchoscopy:atypical cell clusters with oval and polygonal cells mixed with blood. Cells contain enlarged, hyperchromatic, pleomorphic nuclei and eosinophilic cytoplasm, and prominent nucleoli, compatible with adenocarcinoma of lung (H&E stain x100).
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The histology (Figure 5) and immunohistochemistry from the tissue obtained by bronchoscopy confirmed a poorly differentiated adenocarcinoma of the lung.