Clinical History and Examination
The patient is a 68-year-old elderly male who worked as a sanitation worker. He sought medical attention at Fushun County People’s Hospital due to ”coughing and hemoptysis for over a month.” An enhanced CT scan conducted on March 28th, 2023, revealed: 1. The appearance of a patchy shadow in the lingular segment of the left upper lobe with obstructed bronchus accompanied by obstructive inflammation; the exact cause needs further confirmation through a bronchoscopy examination. 2. Scattered patches, nodules, and linear images in both lungs, adjacent to the pleura with retraction, suggesting a high probability of secondary pulmonary tuberculosis. On March 29th, 2023, the patient underwent a bronchoscopic examination, and a tNGS test was performed on the bronchoalveolar lavage fluid, which revealed a positive result for Mycobacterium tuberculosis and the Enterobacter cloacae complex. A biopsy indicated non-small cell lung cancer, and the immunohistochemistry results were as follows: left upper lobe biopsy tissue showed tumor cells positive for CK, P40, and CK5/6, and negative for Syn and TTF-1. P53 was approximately 40% positive, and Ki-67 was approximately 40% positive. Based on HE staining and immunohistochemistry diagnosis, squamous cell carcinoma was suggested (Figure 1A).
The patient visited our hospital (The First People’s Hospital of Zigong) on April 4th, 2023. He denied any history of smoking, alcohol consumption, or exposure to epidemic areas. Our hospital’s tests showed: CEA 0.88ng/ml, SCC antigen 0.93ng/ml, and Cyfra 21-1 7.55ng/ml. A whole-body bone scan SPET-CT suggested a dot-like radiopharmaceutical enhancement image in the right paranasal sinus area, suggesting a benign lesion; no definitive signs of bone metastasis were observed (Figure 1B). Pulmonary function tests indicated moderate obstructive pulmonary ventilation dysfunction. A TB infection T-cell culture γ-interferon test was performed, showing the following results: Lymphocyte culture+IFN(N) 4.4 pg/ml, Lymphocyte culture+IFN(T) 144.60 pg/ml, Lymphocyte culture+IFN(P) 921.40 pg/ml, TB-IGRA(T-N) 140.20 pg/ml. The results were deemed positive.
A thoracic CT scan indicated a persistent patchy shadow in the lingular segment of the left upper lobe (Figures 2A, B). Abdominal and cranial enhanced CT scans showed multiple nodules in the right lobe of the liver with progressive enhancement, suggesting hemangiomas that require follow-up observation; multiple cysts were also observed in the liver along with calcifications. The cranial CT did not show any abnormalities, but there was a deviated nasal septum and inflammation in the left ethmoid sinus.