Description
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.
History
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.