A 16 year old girl presented with gradual onset breathlessness from one year and imaging studies showed diffuse left upper and middle lobe and right middle lobe opacities. A CT scan showed hyper dense, vaguely defined LUL and LML regions of the lungs. No well defined mass was visualized on either lung fields. She subsequently had undergone left upper lobectomy.

The specimen received was a left upper lobectomy, which on sectioning showed most of the lung parenchyma being replaced by diffuse tan- pink nodular mass like lesions growing along the bronchio-pulmonary airways. The larger airways showed papillary and micro-papillary lesions lining the mucobronchial mucosa.

The H&E micro pictures shown here are from the region of lung near to the main stem left bronchus.

Image a is at 10x, Image b is at 20x, Image c is at 40x

Please, send your answers to Dr. Sushama Patil, MD at   sushma_patil1@yahoo.com
Pathology Resident
Department of Pathology
Washington University School of Medicine
St. Louis MO, USA