Quiz. What is your diagnosis?

A 40-year-old woman presented to our hospital with cough and hemoptysis for one week. She denied any systemic disease before but is a heavy smoker of 20 cigarettes per day for more than 20 years. She also had a personal history of fostering a dog at home. During the survey of the cause of these symptoms, chest plain film and computed tomography (CT) were performed. A focal cavitary mass lesion measuring 4.5 cm in diameter was noted at chest CT scan (Fig. 1). Either pulmonary tuberculosis or primary lung cancer was suspected. For definite diagnosis and symptom treatment, wedge resection of the lung mass lesion by video-assisted thoracoscopic surgery (VATS) was done by chest surgeon. Gross examination of the resected lung revealed a tan and solid nodule with necrosis and focal cavitation, measuring 4.3 × 4.2 × 4.0 cm (Fig. 2). Microscopically, the mass-like lesion exhibited granulomatous inflammation with central necrosis surrounded by epithelioid histiocytes (Fig. 3A and 3B). Inside the necrotic center, there were some dead and degenerated parasites (Fig. 3C and 3D).

I-Wei Chang1,2, Mpendulo Felix Gule3
1Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan
2Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
3Mbabane Government Hospital, Mbabane, Swaziland