The computed tomography corresponded to a collapsed right lung due to a poorly defined expanding mass. The bronchoscopy revealed narrowing of the substandard and medium lobar bronchi. The patient designed irreversible shock and died. At 3CAI the right lung substandard lobe was extensively replaced by a grayish diffuse neoplasia in a pneumonia-like gross pattern. Metastatic disease was found in the right adrenal gland and thoracic and abdominal lymph nodes. Microscopic dissemination through lymphatics, pleura, and airways was detected. Histological examination revealed a poorly differentiated adenocarcinoma with hepatoid features. Immunohistochemmistry stains were positive for keratin 7, polyclonal carcinoembryonic antigen (CEA) in a diffuse pattern, AFP and HepPar-1 antibody. TTF-1 showed a diffuse granular cytoplasmic staining of the neoplastic cells, and only focal nuclear positivity. Multiple bilateral emboli originated from deep venous thrombosis were present in large and medium branches of the pulmonary artery and contributed to the cause of death. strong class=”kwd-title” Keywords: Adenocarcinoma, Lung Neoplasms, Carcinoembryonic Antigen, Pulmonary Embolism, Autopsy CASE Statement A 66-year-old, black, male patient sought medical attention because of a 10-day history of productive cough and dyspnea. 3CAI He referred respiratory complaints, recurrent pneumonia and excess weight loss during the last 10 months, raising the suspicion of lung malignancy by the primary care physician. His past medical history was uneventful, but he had been a heavy smoker for 40 years. Physical examination showed an ill-looking patient, emaciated, pale, showing mild respiratory distress. Blood pressure = 160/110 mmHg, pulse rate = 112 beats per minute, respiratory rate = 32 respiratory movements per minute, and room air flow pulse oximetry = 83%. Edema was present in lower limbs. Lung examination revealed decreased bronchial breath sounds in the right hemithorax and scattered crackles. Cardiac and abdominal examinations were normal. Initial treatment comprised supplementary O2 by nasal catheter and antibiotics. The patient was hospitalized for further investigation. The initial laboratory assessments are in Table 1. Table 1 C Admission laboratory workup thead th valign=”top” align=”left” scope=”col” style=”border-top: solid 0.50pt; border-bottom: solid 0.50pt” rowspan=”1″ colspan=”1″ /th th valign=”top” align=”left” scope=”col” style=”border-top: solid 0.50pt; border-bottom: solid 0.50pt” rowspan=”1″ colspan=”1″ /th th 3CAI valign=”top” align=”left” scope=”col” style=”border-top: solid 0.50pt; border-bottom: solid 0.50pt” rowspan=”1″ colspan=”1″ RV /th th valign=”top” align=”left” scope=”col” style=”border-top: solid 0.50pt; border-bottom: solid 0.50pt” rowspan=”1″ colspan=”1″ /th th valign=”top” align=”left” scope=”col” style=”border-top: solid 0.50pt; border-bottom: solid 0.50pt” rowspan=”1″ colspan=”1″ /th th valign=”top” align=”left” scope=”col” style=”border-top: solid 0.50pt; border-bottom: solid 0.50pt” rowspan=”1″ colspan=”1″ RV /th /thead Hemoglobin12.312.3-15.3 g%Creatinine0.50.4-1.3 mg/dLHematocrit37.636.0-45.0%Potassium4.53.5-5.0 mEq/LLeucocytes25.44.4-11.3 103/mm3Sodium135136-146 mEq/LBands01-5%ALT189-36 U/LSegmented9545-70%AST1810-31 U/LEosinophils01-4%Total bilirubin0.390.3-1.2 mg/dLBasophils00-2.5%Glucose (random)10970-140 mg/dLLymphocytes318-40%LDH324120-246Monocytes22-9%Cai+1.111.11-1.4 mmol/LPlatelets453.103150-400 103/mm3Total protein7.07-8 g/dLCRP158 5 mg/LAlbumin3.63-5 g/dLBUN135-25 mg/dLPT (INR)1.41 Open in a separate window ALT = alanine aminotransferase; AST = aspartate aminotransferase; BUN = blood urea nitrogen; Cai+ = ionized calcium; CRP = C-reactive protein; LDH = lactic dehydrogenase, PT = prothrombin time; RV = reference value. Room air flow gasometry revealed: pH = 7.44; pO2 = 52 mmHg; pCO2 = 44 mmHg; HCO3 = 28 mEq/L; BE = 3.7, and oxygen saturation = 88%. Chest radiography showed diffuse and homogeneous opacity of the right hemithorax and right bronchus obliteration without a significant deviation of the mediastinum, suggesting pulmonary atelectasis associated with pleural effusion. A perihilar alveolar opacification was seen on the left lung (Physique 1). Open in a separate window Physique 1 C Total opacification of the right hemithorax. Note obliteration of ipsilateral main bronchus and foci of perihilar alveolar opacity around the left lung. The chest computed tomography showed volumetric reduction of the right lung parenchyma, which had totally collapsed, with bronchial and alveolar areas stuffed in by liquid content (Body 2). The basal sections got heterogeneous attenuation with some parenchymal calcifications, which recommended the current presence of a badly Slit3 delimited growing mass (Body 3). Best pleural enhancement in comparison effusion and moderate was present. Ground-glass opacity areas connected with diffuse interstitial thickening exhibiting a mosaic design was within the still left lung (Body 4). Poorly defined subpleural nodules were depicted also. Dilation from the trunk from the pulmonary artery was noticed. Calcified mediastinal lymph nodes 3CAI had been noticed without proof mediastinal lymph node enhancement. Open in another window Body 2 C Axial computed tomography (CT) from the upper body C mediastinal home window C displaying voluminous hypodense collection with discrete 3CAI pleural thickening and improvement connected with retraction from the apex of the proper hemithorax. Open up in another window Body 3 C Axial CT from the upper body C mediastinal home window. A – Hypodense water content in the proper main bronchus (arrow) and heterogeneous improvement of.