PMC7582100_01
CT scan of chest showed upper lobe predominant bronchiectasis.
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His computed tomography (CT) scan of chest showed diffuse bilateral upper lobe predominant bronchiectasis with areas of bronchial wall thickening and mucous plugging in peripheral airways (Fig. 1).
Hematoxylin and eosin stain in low power view showed an abrupt change from normal lung parenchyma (right side of images) to area with complex papillary architecture, enlarged hyperchromatic atypical nuclei and septal thickening.
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To our surprise, an eight-millimeter focus of invasive adenocarcinoma was noted on hematoxylin and eosin stains (Fig. 2).
High power view showed malignant nuclear features including nuclear pseudo inclusions.
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The adenocarcinoma was in an area relatively spared of the marked inflammation surrounding the airways (Fig. 3).
Immunohistochemical staining for TTF-1 suggested primary lung carcinoma.
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Pulmonary Function Test before and after lung transplant surgery showed significant improvement in function.
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Over the year the patient had significant improvement in lung function and exercise tolerance (Fig. 5).