Placental transmogrification of the lung presenting as progressive symptomatic bullous emphysema

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. Figure 1 CT of the thorax showing bullous–cystic changes with atelectasis of the adjacent parenchyma and displacement of the upper lobe and mediastinum. Grossly, the specimen displayed multiple cysts with compression of the adjacent parenchyma (figure 2A). Histologically, placenta-like papillary …