PMC6011045_01
Computed tomogram of the chest in lung windows shows honeycombing (red arrows), subpleural reticulation (green arrows), and extensive consolidation (yellow arrows) that pathologically demonstrated organizing pneumonia with adenocarcinoma in situ with invasion on explant pathology.
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Computed tomography (CT) of the chest showed an interstitial lung process with an apical-to-basal gradient, with peripheral reticulation and honeycomb formation (Fig. 1), consistent with a usual interstitial pneumonia (UIP) pattern. The patient's chest CT also showed a bilateral, dense consolidative process involving both lower lobes of the lungs with imaging features consistent with superimposed pneumonia on the background UIP or a UIP flare-up (Fig. 1).
Hematoxylin and eosin stain of adenocarcinoma from explanted lungs. A] Invasive focus of well-differentiated adenocarcinoma (red arrow) B] Interface of adenocarcinoma in situ (yellow arrow) and invasive adenocarcinoma (red arrow) with evidence of fibrotic changes (blue arrow) C] Alveolar walls lined by neoplastic cells with focal cytoplasmic mucin without invasion consistent with adenocarcinoma in situ (yellow arrow) D] High-power view of the interface of invasive adenocarcinoma (red arrow) and adenocarcinoma in situ (yellow arrow).
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The lungs also showed a diffuse, non-mucinous, lepidic-predominant AIS with foci of microinvasion diffusely involving all lobes, measuring 19 cm on the right lung with negative resection margins and no evidence of tumor in resected lymph nodes (Fig. 2).