PMC6586773_01
Chest X-ray AP view showing interval worsening of the bilateral upper and lower lobe patchy airspace opacities with nodular appearance.
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Chest X-ray (Fig. 1) showed diffuse bilateral upper and lower lobe patchy airspace opacities with nodular appearance suggestive of multilobar pneumonia. Consequently, the patient was admitted to the hospital and was started on broad spectrum antibiotics.
CT scan of the chest showing extensive bilateral parenchymal infiltrates with mediastinum lymphadenopathy.
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A CT scan of the chest (Fig. 2) showed extensive bilateral parenchymal infiltrates with mediastinal lymphadenopathy.
Histologic features of pulmonary adenocarcinoma of the pneumonic type A. Low power view of lung tissue shows neoplastic consolidations surrounding terminal bronchovascular bundles (*) in a pattern reminiscent of bronchopneumonia, from which the entity acquires its adjective "pneumonic". Scale bar = 2 mm. B. An alveolar space occupied the characteristic fibroblastic plug an organizing pneumonia (*). The arrowhead points to a reactive type II pneumocyte with hobnail morphology. Surrounding the alveoli are malignant gland forming cells (#) of the adenocarcinoma. Scale bar = 0.25 mm C. The adenocarcinoma showing both an acinar (left side) and solid (right side) pattern of growth. The inset demonstrates a mitotic figure. Scale bar = 0.25 mm, inset = 0.025 mm. D. A terminal bronchiole lined by neoplastic epithelium (*) is identified adjacent to adenocarcinoma. Scale bar = 0.25 mm.
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There was no evidence of invasive aspergillosis on microscopy and tissue cultures were negative for aspergillus or HSV (Fig. 3).