LAUSR

A 53-year-old woman who was a non-smoker with no notable medical history was admitted to The First Norman Bethune Hospital of Jilin University in June 2017. She reported a 20-day history of intermittent coughing, phlegm, and fever up to 38.7°C after having a “cold.” Her condition improved with antibiotic treatment (penicillin and cephalosporin). She described having similar symptoms 6 months previously with fever, coughing, chest tightness, and shortness of breath, which was aggravated by vigorous activity and improved with medication. Her physical examination showed sinus tachycardia with a pulse rate of 118 beats/min. Her vital signs included a normal body temperature, respiratory rate of 19 breaths/ min, and blood pressure of 108/71 mmHg, and her breath sounds were equal and normal. On admission, she underwent chest computed tomography scanning, which showed shrinkage of the lower lobe of her left lung with some areas of calcification [Figure 1A]. The sub-ordinate bronchi were narrow or warped, and a shadow with increased density was observed [Figure 1B]. Fiberoptic bronchoscopy revealed a new occupying lesion with smooth surface in a sub-branch of the lower lobe of the right lung, which was causing closure of the bronchial tube [Figure 1C]. Purulent secretion was seen within the terminus of the left main bronchial tube, where the lumen showed marked stenosis and the mucosa was rough and swollen [Figure 1D]. Immunohistochemical analysis revealed positive staining for Ki-67 (+ 1%), ck-pan (scattered +), CD56 (+), CgA (+), and Syn (+). The pathological and immunohistochemical results were consistent and confirmed that the sub-bronchial neoplasm in the lower lobe of the right lung was OCTL [Figure 1E]. Biopsy of the mucosa of the lower lobe of the left lung