LUNG - Tuberculosis and carcinoma

This is part of the apical and posterior segments of the upper lobe of the lung. The pleural surface shows dense fibrous adhesions, and the cut surface shows an irregularly scarred area around the central cavity. There are small foci of caseous material here and there, and there is apparent scarring, which is perhaps tumour in the lesion. The cavity present has perforated on the pleural surface.
This man was seen in May 1977 with intermittent small haemoptyses over a 2 year period, with a weight loss of 10 kilos. He went to his doctor eventually because of back pain, and he was found to be short of breath; a chest X-ray showed cavitated tuberculous disease in the apical segments of both lungs. The sputum was found to contain tubercle bacilli, and he was treated with anti-tuberculous drugs. He did improve but, ultimately, it was felt that resection was advisable, and this was done. The histology of the lesion is that of a tuberculous lesion, in which there are a few acid-fast bacilli, and a very well-differentiated adenocarcinoma of the lung, extending through to the pleural surface.