PMC8683194_01
CT chest with diffuse mosaic attenuation and multiple pulmonary nodules: (a) 4 mm right upper lobe nodule; (b) 4 mm right middle lobe nodule; (c) 7 mm lateral right middle lobe nodule with confluent 1.8 cm medial right middle lobe nodule; (d) 4 mm left lower lobe nodule.
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A repeat CT chest 3 months later indicated no change in diffuse mosaicism and multiple pulmonary nodules, similar in size, with the largest 1.8 cm in the right middle lobe (Figures 1(a)-1(d)).
(a) Monarch robotic-assisted navigational bronchoscopy path to the right middle lobe lung nodule. (b) Axial computed tomography imaging superimposed on the robotic-assisted pathway to the right middle lobe lung nodule.
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She then underwent robotic-assisted navigational bronchoscopy with fine needle aspiration, brushing, and transbronchial biopsy of the right middle lobe nodule (Figures 2(a) and2(b)).
(a) H&E stain of the medial right middle lobe nodule. (b) Medial right middle node nodule with chromogranin-positive pathology, a neuroendocrine marker. (c) Medial right middle lobe nodule with synaptophysin-positive pathology, another marker for neuroendocrine cells. (d) Medial right middle lobe nodule with a Ki-67 proliferation marker with only 3 nuclei staining positive.
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Pathology was positive for chromogranin and synaptophysin, neuroendocrine markers, and low Ki-67 positivity, indicating low rate of proliferation (Figures 3(a)-3(d)).