PMC8636697_01
Patient 1 chest CT. (A and B) A n irregular solid nodule in the anterior segment of the upper lobe of the right lung and lamellar density shadows in the lower lobe of the right lung on March 20, 2018. (C and D) Multiple patchy high-density shadows are evident in both lungs, with lesions of the right upper lung still being visible during an ICU stay on June 4, 2018. (E and F) After effective antifungal therapy, the high-density shadow of the two lungs was basically absorbed, the lesion of the right upper lung was almost the same as before, and the left pleural effusion was increased on June 25, 2018. (G and H) The nodules in the right upper lobe of the lung were significantly larger, and the lesions in the lower lobes of both lungs were stable on January 15, 2019.
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He was admitted to our hospital on March 19th, and chest computed tomography (CT) showed an irregular solid nodule in the anterior segment of the upper lobe of the right lung and lamellar density shadows in the lower lobe of the right lung (Figure 1A and B). T. marneffei was cultured from lung biopsy tissue performed on June 4, and chest CT showed growth of the two lung lesions (Figure 1C and D). He was discharged after a chest CT showed that the lung lesions were significantly smaller (Figure 1E and F) on June 25. A chest CT showed that the nodules in the right upper lobe of the lung were significantly larger and that the lesions in the lower lobes of both lungs were stable on January 15, 2019 (Figure 1G and H).
(A-D) There were tumor cells in the upper right lobe, some of which were glandular and micropapillary. (A) HE staining, x200. (B) CK (+), x200. (C) CK7 (+), x200. (D) Napsin A (+), x200.
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TBLB performed in the anterior segment of the right upper lobe showed primary adenocarcinoma (Figure 2A-D). The patient was confirmed to have right lung adenocarcinoma and TSM.
PMC8636697_02
Patient 2 chest CT. (A and B) Multiple nodules in the upper lobe of the left lung and a mass in the left hilar lung on January 24, 2018. (C and D) The lung lesions of the upper lobe of the left lung and left hilar lung increased on January 31, 2018. (E and F) The lesion in the upper lobe of the left lung was enlarged, and the mass of left hilar was reduced, on August 27, 2018. (G and H) The lesion in the upper lobe of the left lung continued to enlarge, and the mass of left hilar was the same as before on November 6, 2018.
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A chest CT showed multiple nodules in the upper lobe of the left lung, a mass in the left hilar lung and a mass in the middle lobe of the right lung with mediastinal and left hilar lymph node enlargement (Figure 3A and B). A chest CT on January 31 showed that the pulmonary lesions had increased in size (Figure 3C and D). After one week, cefoperazone tazobartan and linezolamide were discontinued, and chest CT on August 27, 2018 showed that the lesion in the upper lobe of the left lung was larger, but the mass of the left hilum was smaller (Figure 3E and F). A chest CT showed that the lesion in the upper lobe of the left lung had enlarged, and on November 6, 2018, the mass of the left hilar was the same as before (Figure 3G and H).
(A and B) Microbiological examination-colony morphology: T. marneffei is thermally dimorphic, growing as a mycelium at 25 C (A) and as yeast-like cells at 37 C (B) on Sabouraud dextrose agar for two weeks.
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TBNA tissues on February 4 (Figure 4A and B). Thus, voriconazole at 200 mg orally every 12 hours and amphotericin B at 30 mg/day intravenously were prescribed.
(A-D) Biopsy of the upper lobe of the left lung indicated infiltration of lung adenocarcinoma. (A) HE staining, x200; (B) CK (+), x400; (C) CK7 (+), x200; (D) P40 (+) x100.
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The pathology was confirmed as infiltrating adenocarcinoma, and no epidermal growth factor receptor mutation was observed (Figure 5A-D).