PMC8132097_01
Initial and follow-up chest CT findings: (a) The initial transverse CT scan revealed diffuse bronchial wall thickening and luminal narrowing of the lobar and segmental bronchi. (b) The initial coronal CT scan revealed a 7.7 mm diameter mass-like lesion suggesting endobronchial tumor in a left lingular bronchus (arrow) and enlargement of multiple mediastinal LNs enlargement. (c) On the follow-up transverse CT scan, the bronchial wall thickening had significantly improved. (d) On the follow-up coronal CT scan, previous mass-like lesion and mediastinal LNs significantly decreased.
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Lymph nodes (LNs) 1L, 7, and 9R were enlarged, suggesting metastasis or reactive changes related to infectious causes such as bronchitis (Figure 1(a) and (b)). Follow-up CT demonstrated a significant improvement of overall bronchial wall thickening (Figure 1(c)) and the decrease in the size of enlarged mediastinal LNs (Figure 1(d)).
Initial and follow-up bronchoscopic and pathological findings. (a) Initial bronchoscopy revealed bronchial narrowing and edematous bronchial mucosa with suppurative inflammation of the lingular segment. (b and c) Hematoxylin and eosin staining of the initial biopsy reveal moderate-to-severe suppurative bronchitis and a few atypical cell clusters consistent with squamous cell carcinoma. (d) Immunohistochemistry of cytokeratin 5/6 in initial biopsy specimen. (e) Immunohistochemistry of p63 in initial biopsy specimen. (f) Immunohistochemistry of Ki-67 in initial biopsy specimen. (g) Follow-up bronchoscopy revealed less inflammation, and mucosal edema and redness. (h and i) Hematoxylin and eosin staining of the follow-up biopsy show regenerative epithelium and chronic inflammation without malignant cells. Scale bar: 50 mum.
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Bronchoscopy showed the bronchial narrowing and edematous bronchial mucosa with suppurative inflammation of the lingular segment (Figure 2(a)). Thorough pathology review concluded that it was consistent with squamous cell carcinoma (Figure 2(b) and (c)). Immunohistochemistry revealed that the epithelial cells were positive for p63 and CK5/6, and the Ki-67 index was 50% (Figure 2(d)-(f)). Fortunately, the mucosal edema with purulent inflammation had markedly improved and only mucosal edema and redness remained (Figure 2(g)). Interestingly, the second pathology report showed only mild chronic inflammation without cancer cells (Figure 2(h) and (i)).
Initial PET-CT scan, last chest CT scan, and bronchoscopic finding. (a and b) Initial PET-CT scan showed no hypermetabolic lesion. (c) Last chest CT scan performed at about 4 years after initial diagnosis showed no recurrence of squamous cell cancer. (d) Last bronchoscopic finding was normal.
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At the same time, the positron emission tomography (PET) scan showed no evidence of malignancy (Figure 3(a) and (b)). Last chest CT scan performed at about 5 years after initial diagnosis showed no recurrence of squamous cell cancer (Figure 3(c)). The last bronchoscopic finding was also non-specific and the cytology of bronchoalveolar lavage showed no malignant cell (Figure 3(d)).