PMC4674011_01
Chest radiograph, computed tomography scan, and positron emission tomography scan. (A) A chest radiograph showing consolidation in the lower area of the right lung and a restiform shadow in the bilateral apical portions. (B) Chest computed tomography showing consolidation of the right lower lobe. (C) Positron emission tomography showing 18F-fluorodeoxyglucose accumulation in the consolidation of the right lower lobe.
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A chest radiograph showed consolidation in the right lower lung field and restiform shadows in the bilateral apical portion (Fig. 1A). Chest computed tomography showed consolidation of the right lower lobe (Fig. 1B), and positron emission tomography revealed accumulation of 18F-fluorode-oxyglucose within the consolidation (Fig. 1C) and right mediastinal lymph nodes (4R) (not shown).
Bronchoscopic examination. Multiple nodules were observed on the bronchial mucosa; these nodules had not been identified on chest computed tomography. (A) Nodule on the left side of the carina. (B) Nodules on the right superior lobar bronchus. (C) Nodules on the intermediate bronchus. (D) Nodules on the basal bronchus; the arrow indicates the point of biopsy. These nodules extended from the right lower bronchus to the proximal bronchi and carina.
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Bronchoscopic examination revealed multiple nodules, at least eight nodules on the bronchial mucosa, which were not present in the submucosal lesion and not identified on the chest computed tomography (Fig. 2). We performed biopsy from two locations - proximal (shown in Fig. 2, arrow) and distal nodule - under the X-ray guidance (not shown in Fig. 2).
Pathological examination (hematoxylin and eosin stain; original magnification, x400). (A) Proximal biopsy specimen and (B) distal biopsy specimen. Light microscopy showed poorly differentiated squamous cell lung cancer. The arrow indicates intercellular bridges. Immunohistochemical staining of CEA, p40, and p63 showed similar stainability.
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Furthermore, immunohistochemical stain revealed similar stainability (Fig. 3A and B).