PMC6080217_01
CXR showing Right lung diffuse interstitial opacities.
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Chest X Ray showed diffuse interstitial and airspace opacities throughout the right lung, a small right pleural effusion and a clear left lung (Fig. 1).
CT chest showing diffuse right sided interstitial reticulonodular changes.
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Differential included atypical infection versus lymphangitic carcinomatosis (Fig. 2).
High resolution papillary lung adenocarcinoma with psammomatous calcifications.
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Endobronchial biopsies showed poorly differentiated adenocarcinoma with papillary architecture (Fig. 3) and extensive concentric psammomatous calcifications but no lymphangitic spread on transbronchial specimens.
Immunohistochemistry positive for TTF-1.
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Immunohistochemistry was positive for cytokeratin, TTF-1, CK7 and focally for CK20(Fig. 4).