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Sixty-four-year-old man with non-productive cough and lung mass
  1. Irfan Ismail Ayub1 and
  2. Thanka Johnson2
  1. 1 Pulmonary Medicine, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
  2. 2 Pathology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Irfan Ismail Ayub, iia{at}


A 64-year-old manpresented with non-productive cough and dyspnoea and was evaluated and diagnosed to have a left lung mass on CT of the chest. A transthoracic needle biopsy under CT guidance revealed necrotic tissue on histopathology and was inconclusive. Positron emission tomography scan revealed a fluoro-deoxyglucose-avid left lung mass with a left upper lobe luminal cut-off. A flexible video bronchoscopy was performed and revealed left upper lobe complete obstruction with an endoluminal plug which was removed in piecemeal fashion, and deeper biopsies were taken from the lingula. Histopathology revealed underlying adenocarcinoma colonised by aspergillosis. This case serves to remind us of the possibility of missing underlying malignancy when taking superficial biopsies of clearly visualised endobronchial necrotic tissue and the need for debulking it to a reasonable extent and to take deeper biopsies in order to not miss a possible underlying malignancy.

  • lung cancer (oncology)
  • pneumonia (infectious disease)
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  • Contributors IIA contributed to patient care and management. TJ contributed to pathological examination and reporting. IIA and TJ contributed to manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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