PMC6535463_01
Initial chest CT scan with mediastinal window showing multiple lung masses in the right lung filed with mediastinal lymphadenopathy and small distal tracheal irregular mass.
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In addition, there was a small distal tracheal mass and a significant mediastinal lymphadenopathy (Fig. 1, Fig. 2).
Lung biopsy of the right lower lobe mass. A: tissue magnified by electron microscopy (100X) showing necrotizing acute and chronic inflammation with granulomatous features and associated sulphur granules with radiating bacterial organisms and three foci of actinomycosis (arrows). B: tissue magnified by electron microscopy (400x) showing a focus of actinomycosis with acute and chronic inflammation.
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CT guided lung biopsy of the largest lower lobe mass revealed necrotizing acute and chronic inflammation with granulomatous features and associated sulphur granules with radiating bacterial organisms consistent with actinomycosis (Fig. 3).
Repeat chest CT scan 8 weeks later with lung window showing worsening right sided lung masses.
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Repeat CT scan eight weeks after initial imaging revealed worsening of the right lung masses and consolidation with a significant increase in the size of the distal tracheal mass (Fig. 4, Fig. 5).
Tracheal tissue biopsy showing poorly differentiated squamous cell carcinoma magnified by electron microscopy by (100X - A) and (400X - B).
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Biopsy results revealed an invasive squamous cell carcinoma of the trachea most likely of primary origin (Fig. 6, Fig. 7).