PMC5552382_01
CT Chest axial (left) and coronal (right) images showing diffuse bilateral confluent nodular and air space opacities with areas of consolidations.
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Repeat CT Chest was performed after twelve days of her hospitalization which revealed extensive confluent nodular opacities in both lung fields with more focal area of mass-like consolidation in the left upper lobe and several mediastinal nodes (see Fig. 1).
Adenocarcinoma of acinar pattern, with immunostains of TTF-1 positive (left), and low-power micrograph (right).
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Transcription termination factor, RNA polymerase 1 (TTF-1), and fluorescence in-situ hybridization (FISH) was negative for rearrangement involving anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1) genes. These results reflect a primary origin of the lung, which on biomarker analysis was noted to be epidermal growth factor receptor (EGFR) positive with p.L858R mutation in Exon 21 (see Fig. 2).
PMC5552382_02
CT chest with coronal (left), and axial (right) images showing diffuse bilateral interstitial infiltrates, worse in the upper lungs intermixed with ground glass infiltrates.
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Fig. 3). Further inpatient workup included bacterial, fungal, and viral cultures, immunological workup for connective tissue disease, acid-fast stains, and screening for immunodeficiency; results came back within normal limits.
Micrograph showing adenocarcinoma of micropapillary pattern.
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V-Ki-ras2 Kirsten rat sarcoma (KRAS) and EGFR mutation analysis were negative (see Fig. 4).