case_images: PMC10885847_01
case_images: Initial chest radiograph shows an incidental nodule in the right upper lung field (arrow).
case_images: jbsr-108-1-3461-g1.jpg
case_images: PMC10885847_01_jbsr-108-1-3461-g1.jpg
case_images: F1
case_images: A 60-year-old woman presented to the pulmonologist with a 9-mm solitary lobulated nodule in the right upper lobe as an incidental finding on screening chest radiography (Figure 1) and chest computed tomography (CT) (Figure 2A).
case_images: Chest CT with follow up. (A) 9-mm lobulated nodule with an internal air-bronchogram in the right upper lobe. (B) After 1 year, the nodule shows a minimal increase in size, 9 to 10 mm. (C) After 2 years later from the initial chest CT, the nodule changes from 10 to 13 mm in size, and the somewhat dilated internal bronchus are detected.
case_images: jbsr-108-1-3461-g2.jpg
case_images: PMC10885847_01_jbsr-108-1-3461-g2.jpg
case_images: F2
case_images: A 60-year-old woman presented to the pulmonologist with a 9-mm solitary lobulated nodule in the right upper lobe as an incidental finding on screening chest radiography (Figure 1) and chest computed tomography (CT) (Figure 2A). Furthermore, air bronchograms became more evident and dilated, a feature known to be worrisome (Figure 2B, C).
case_images: Volume: After 1 year, the volume doubling time from the initial state was 844.28 days, and the overall average volume doubling time after 2 years was 369.45 days.
case_images: jbsr-108-1-3461-g3.jpg
case_images: PMC10885847_01_jbsr-108-1-3461-g3.jpg
case_images: F3
case_images: The total volume doubling time (VDT) from the initial to the 2-year follow-up was 369.45 days, indicating a potential malignancy with a value below 400 days (Figure 3).
case_images: Histopathology. (A-B) Hematoxylin-eosin staining slide images show that the papillary tumor is constituted of pseudostratified columnar epithelium covering the fibrotic core. Surrounding alveolar spaces are filled with mucus on frozen (A, x40) and permanent sections (B, x100). (B) The lesion shows multiple papillary fronds lined by stratified and pseudostratified columnar cells. Moderate stromal lymphocytic infiltration and psammoma bodies are noted in the focal peripheral area. (C) In partial areas, small papillae with oncocytic change within the adjacent alveolar spaces are mimicking to the histologic features of the spread through the air spaces of pulmonary adenocarcinoma (x100). (D) Most of the lesion is composed of ciliated or non-ciliated columnar, goblet, and cuboidal cells. There are neither architectural atypia nor cytological atypia (x100).
case_images: jbsr-108-1-3461-g4.jpg
case_images: PMC10885847_01_jbsr-108-1-3461-g4.jpg
case_images: F4
case_images: Frozen sections of the lesion showed a well-demarcated mass containing mucus-secreting oncocytes, cuboidal, and columnar cells (Figure 4A-D).