15 June 2024
: Case report 
Lung Lesions: Differential Diagnoses Beyond Cancer
Unusual clinical course, Challenging differential diagnosis
Paweł Jurczak
1ABCDEF*, Anna Romaszko-Wojtowicz 2ABDE, Anna Doboszyńska 2DE
DOI: 10.12659/AJCR.943798
Am J Case Rep 2024; 25:e943798
Table 2. Summary of the clinical, radiological and histopathological presentation of the cases.
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | |
|---|---|---|---|---|
| History taking | Worse well-being, dry cough | Dry cough, loss of body weight | Dyspnea at rest and on exertion, productive cough | Dry cough, dyspnea on exertion |
| Physical examination | No deviations | No deviations | Weakened alveolar murmur over pulmonary fields, single wheezes | Swollen lower limbs, weaker alveolar murmurs over the left lung |
| Radiological image | A nodular lesion with the diameter of about 9 cm infiltrating the lung hilum connecting to a nodular lesion containing calcifications, situated in the precardiac adipose tissue, which in turn connects to the thyroid tissue | A peripheral nodule measuring 24×13 mm, located in the right lung, and an enlarged lymph node size 12 mm in the right hilum | Emphysematous small-nodular and fibrous lesions. A focal lesion of 48 mm in diameter in the lower field of the left lung | A solid, growing irregularly, extensive nodular and glandular infiltrate size 148×102 mm, remodeling the left lung; cysts size 55×42 mm in the liver, a hypodense focal lesion in the spleen, size 25 mm |
| Histopathological examination | The sampled material found to contain thyroid cells, but no neoplastic growth detected | Visible numerous epitheliocellular granulomas, some with central necrosis. No neoplastic changes were detected | Small fragments of the lung comprising a few pulmonary alveoli with thickened interalveolar septa, with the presence of erythrocytes and hemosiderinophages in the alveolar lumen | Diffused infiltrate from large B cells, proliferation index Ki-67 70% |
| Diagnosis | Ectopic thyroid tissue | Tuberculosis of the lungs | Post-traumatic pleural hematoma | Diffuse large cell B lymphoma |
| * CT scan of the chest; ** core-needle biopsy material. | ||||