What happened, in summary

A man in his 70s had previously undergone lobectomy for a left upper-lobe lung adenocarcinoma. During surveillance, doctors noticed a growing nodule in the right lower lobe. He felt well and had good heart and lung fitness. PET imaging showed mild activity in the nodule, raising concern for another malignancy.

He underwent robotic right lower-lobe superior segmentectomy with mediastinal and hilar lymph-node dissection. Pathology confirmed micropapillary-predominant adenocarcinoma in the right lung, while the sampled lymph nodes were negative for cancer.

The surgical specimen also unexpectedly contained amyloid deposits throughout the lung tissue. Further testing identified wild-type transthyretin amyloidosis, and evaluation also found cardiac involvement and a monoclonal gammopathy of undetermined significance. These conditions led to separate specialist follow-up and treatment with tafamidis for the amyloidosis.

For the lung cancer, surveillance imaging 6 months after surgery showed no evidence of new or recurrent disease.