Misdiagnosis analysis: such a solid mass with many malignant features is actually benign, why?

(The article contains surgical specimens, for the purpose of expressing the content of the case for popular science, please choose carefully and click to read)

Patient A, male, 65 years old, is the father-in-law of a colleague in the hospita.

Lesions appear, elongated strips

Solid density, there are burrs, but the burrs feel long, there are blood vessels entering, and the blood vessels are thicker

Long burr or spinous process sign (purple arrow), vascular sign (orange arrow), density is soli.

Spinous process sign, the edges are relatively straight, or concave, and the blood vessels are thickened

However, the blood vessels extend from the proximal end to the lesion, and do not go to the distal end but thicken, which is not very malignant at the tim.

There is a little ground-glass component around the lesion (green arrow)

The above picture shows obvious burrs, obvious ground glass components, and obvious blood vessel entr.

This layer begins to feel that the lesions are swollen, there are burrs on the edges, and blood vessels have entered

Fine burs with swelling, vascular signs

Vascular sign, burr and round shape (obvious swelling)

burr sign

Bulge and Glitch

The pleura is slightly housed (blue arrow), with obvious burrs (purple arrow)

Glitch sign, feeling a little longer

Ground glass composition (green arrow), burr is slender

Expansion huts with matte edges

There is no broad base or pleural inflammatory thickening with the chest wall, there is no space between them (yellow arrow), and the proximal interlobar fissure has a depression toward the lesion side (brick arrow.

The lateral traction of the interlobar fissure of the lesion is obvious, and the relationship with the chest wall is not like ordinary inflammation

The relationship between the lesion and the chest wall

There is no space between the lesion and the chest wall, but not to the extent of invasion

There is also a thin strip on the pleural side of the mediastinum, but the contraction force is weak

There is a small gap between the lesion and the chest wall

edge of the lesion

In sagittal view, the bronchial truncated (yellow arrow) of the lesion is seen, with fine burr on the edge and uneven surface (purple arrow)

There are lobulations on the surface of the lesion (brick arrows), and the interlobular pleura is indented (blue arrows)

Coronal view feels less malignant, with flatter margins, lack of significant expansion, burrs that are too long and slender

Image impression:

The examination revealed a solid mass occupying the right upper lobe, with burr spinous processes, lobulation, bronchial truncation, and blood vessel entry, and obvious swelling in some layer.

Image of lump in armpit:

The image above is an MRI image, the tissue between the red arrows is a mass, consider a lipoma

Surgery results:

We performed single-port thoracoscopic partial resection of the right upper lobe plus axillary lumpectom.

The appearance of the lump in the upper right lobe is dark in color and shriveled on the surface, but it does not feel very dry, and it looks a little moist

After the incision, the lesions appear to be a little moist and not dense, which is not very consistent with the usual malignant one.

The picture above is a lipoma

Intraoperative delivery showed:

Chronic inflammation with fibrinous exudation in the alveolar space, consider organizing pneumoni.

Comprehension:

Compared with ground glass nodules, it is more difficult to judge the nature of solid lung mas.

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