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.