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In 2015, a 63-year-old non-smoking male with a history of bullous emphysema, for which a wedge resection of the right lower lobe had been performed in 1972, presented with progressive dyspnoea on exertion and coughing. Pulmonary function tests demonstrated a moderate obstructive pattern with normal diffusion capacity (FEV1: 61%, FVC: 64%, TLco: 86%). CT of the thorax revealed localised bullous–cystic changes in the right lower lobe with displacement of the mediastinum to the contralateral side (figure 1). Due to the patient’s increasing respiratory distress, a right lower lobectomy was performed.
Grossly, the specimen displayed multiple cysts with compression of the adjacent parenchyma (figure 2A). Histologically, placenta-like papillary …