PMC8100318_01
(A) Chest CT scan showing a nodule accompanied by calcification (blue arrow) in the left hilum 1 month prior. (B, C) Chest CT scan showing that the nodule grew to become a large high-density mass (blue arrow) that compressed the adjacent left upper lobe bronchus (white arrow) and had multiple nodules/patches/stripes partly accompanied by calcification (black arrow) in the left lung parenchyma and pleural effusion (yellow arrow). (D) Contrast-enhanced chest CT scan showing that the mass occluded the pulmonary artery (red arrow). (E, F) Three-dimensional volume rending image clearly showing the mass invaded the left pulmonary artery and left upper lobe bronchus (blue arrow). (G) Bronchoscopy showing mucosal protrusion (blue arrow) in the left upper lobe bronchus accompanied by mucosal congestion and lumen stenosis. (H) Histopathology image showing tumor cells and osteoid matrix (H&E).
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The patient reported a history of cough and hemoptysis 1 month previously, at which time a chest CT scan showed a nodule in the left lung hilum accompanied by calcification ( Figure 1A ), which was initially diagnosed as pulmonary tuberculosis; this patient then received anti-tuberculosis treatment and was discharged after improvement. To exclude the possibility of malignancy, the patient underwent a chest CT scan again, and multiple nodules partly accompanied by calcification in the left lung parenchyma, an enlarged high-density mass compared to that on the previous scan in the hilum of the left lung and pleural effusion were observed ( Figures 1B, C ). The contrast-enhanced CT scan and three-dimensional volume rendering image revealed that the large high-density mass in the left hilum invaded the adjacent left pulmonary artery and vein and bronchus of the upper lobe ( Figures 1D-F ). On bronchoscopy, the bronchus mucous membrane of the left upper lobe was swollen and congested, accompanied by mucosal protrusion and lumen stenosis ( Figure 1G ). The pathological examination showed that the tumor tissue involved the whole left lung, but there was no evidence of pleural involvement, positive bronchial margins, or local lymph node metastasis ( Figure 1H ).
(A-C) Contrast-enhanced CT scan showing that the tumor recurred in the left lung hilum with multiple metastases in the left pleura and somatic muscles (blue arrows). (D-F) 99mTc-MDP SPECT/CT images showing the areas (blue arrows) with high concentrations of radioactivity, which were consistent with those on the CT scan.
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Four months after the operation, a contrast-enhanced CT scan demonstrated tumor recurrence in the left hilum and multiple metastases in the left pleura and somatic muscles, which showed high concentrations of radioactivity on 99mTc-MDP SPECT/CT examination ( Figure 2 ).
(A, B) Six months after the operation, contrast-enhanced CT scan showing enlargement of the recurrence and metastases (blue arrows). (C) Esophageal barium radiography showing that the tumor at the left hilum had compressed the adjacent esophagus (white arrow).
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Six months after the operation, a contrast-enhanced CT scan revealed enlargement of the recurred local tumor and metastases, especially the lesion at the left hilum, causing compression of the adjacent esophagus ( Figure 3 ).