The case is 47 years old moderately well developed poorly, nourished male farmer,.
Family history and past history are not contributory.
Symptoms started 8 years ago with right shoulder and upper chest pain, and followed
by fever and productive cough in few month. Smelled foul smell in expectoration and
increased in amount gradually. Hemoptysis started 5 years ago and repeated it several
times every year thereafter. In the past several years he often spat up whitish hair
mixed sticky expectoration. On admission, he appeared poorly nourished, pale and
chronically ill appearing.
But was slightly dyspneic only on exertion without high fever. Physical examination
revealed no other visible defect or deformity in any part of body, nor any palpale
nodules. There was dulness on percussion on right upper chest with markedly
diminished breathing sound Showed marked clubbing fingers. B.P. 90/60. Hemoglobin 6.8
gm%, sputum negative for AFB though it was once diagnosed as pulmonary
tuberculosis in the past, and others insignificant.
During the hospitalization, he used to raise up 300-650 ㎖ of sputum but continued
with normal fever, and hemoglobin also improved to 11.3 gm%, Erythrocyte
sedimentation rate improved from 70㎜, to 23㎜/hr. Total serum protein increased
slightly with great increase of γ-globulin.
ECG was normal, bronchoscopy showed a big tumor mass in posterior wall of right
main bronchus, and the biopsy specimen from that lesion was reported as fibrous polyp.
Bacterial culture of sputum showed ordinary throat flora but no predominant one.
Pneumonectomied right lung contained big fibretic ployps protruding into the bronchus
which fave impression of arising from the bronchus. It was hard to find where did it
come from even in operation or on histo-pathological examination but the tissue was
found to contain tubular structure which is covered by pseudostratified epithelium,
cartilage plates, mucosal mixed glands, and also mixed with pancreatic tissues. Ployp
was also covered by the suin which is consisting of hair follicle, sebaceous glands and
sweat glands.
|