Case 8--Persistent Lung Mass

Clinical summary: A 43-year-old, male smoker (1/2 ppd x 25 y) presented in 9/96 with hoarseness. In 1982, he was admitted to another hospital with fever, chills, sweats, and a 2 x 2 cm radiographic opacity in the superior segment of the LLL. A PPD skin test was positive, but stains and cultures for AFB were negative on sputum and lavage fluid. In 5/90 he visited chest clinic with a history of 6 mo of night sweats. Chest radiographs showed minimal to no progression of the LLL nodule, which was also noted in 1987 and 1989. A CT scan showed a 2 cm nodule without calcification or adenopathy. By bronchoscopy, a white plaque was seen in the same region; brushings showed squamous metaplasia. Cultures for AFB were negative. The patient declined therapy. Radiographs taken over the next 6 y showed slight changes in size and intermittent air-fluid levels. He had coronary artery bypass grafts placed in 1/95. In 1/96, he was evaluated for enlargement of the LLL nodule, persistent night sweats, weight loss, and new scant hemoptysis. A CT scan showed cavitation of the mass. In 9/96, bronchoscopy for hoarseness showed a white, granular plaque on the left vocal cord. The airways were unremarkable. Cultures of lavage fluid yielded a mixture of gram negative rods and enterococcus. A benign papilloma of the vocal cord was subsequently removed. In 12/96, he underwent left lower lobectomy for presumed chronic infection or benign tumor.

Gross and histopathologic findings:Image 1 | Image 2 | Image 3 | Image 4 | Image 5 | Image 6 | Image 7