A 78-year-old man with a 40 pack-year history of smoking presented to the emergency department with 3 days of hemoptysis in a volume less than 20 mL/day, cough, low-grade fever, and 1-month history of dyspnoea on exertion. Previously, cefuroxime axetil had been administered with no response. He denied chest pain, wheezing, decreased appetite or weight loss. He experienced fatigue over the last 4 years. No occupational or environmental exposures were noted. His medical history included coronary disease and hypertension. He was found to have IgM lambda monoclonal gammopathy on serum protein electrophoresis with a serum M-protein concentration of 2.300 g/dL (normal 0.64–1.30 g/dL) 3 years ago, received no firm diagnosis. No myeloid or lymphoid neoplasia was detected in the bone marrow biopsy. He had undergone six chest CT examinations over the prior 4 years, demonstrating an irregularly shaped mass-like consolidation in the left lower lobe (figure 1A,B). He underwent a bronchoscopy 4 years earlier with negative bronchial cytology and cultures of bronchial washings for bacteria, fungi, and mycobacteria species. The last chest CT was 6 months ago revealed worsening of left lower lobe consolidation with distended bronchi (figure 1C,D). Unfortunately, he stated that he did not want any further investigation. Figure 1 Serial chest CT imaging, haematological, bronchoscopic and histological findings of the patient. (A, B) Chest CT performed 4 years ago revealed an irregularly shaped mass-like consolidation in the left lower lobe. (C, D) Chest CT performed 6 months ago showed an enlarged left lower lobe consolidation with airways within the lesion. (E, F) The chest CT performed at admission showed a worsening of left lower lobe consolidation associated with bilateral ground-glass opacities and a left pleural effusion. (G) Serum protein electrophoresis showed elevated levels of gamma globulin. (H) Serum immunofixation electrophoresis showed a dense abnormal zone of restriction in the IgM lane and the lambda light chain lane. (I, J) The …

中文翻译：

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持续整合：MALT-easer

一名 78 岁男性，有 40 包年吸烟史，因 3 天咯血量低于 20 mL/天、咳嗽、低烧和 1 个月呼吸困难病史而到急诊科就诊在努力。以前，头孢呋辛酯的使用没有反应。他否认胸痛、喘息、食欲下降或体重减轻。在过去的 4 年里，他经历了疲劳。未发现职业或环境暴露。他的病史包括冠心病和高血压。3年前血清蛋白电泳发现IgM λ单克隆丙种球蛋白病，血清M蛋白浓度为2.300 g/dL（正常为0.64-1.30 g/dL），未得到明确诊断。骨髓活检未发现髓样或淋巴样瘤。在过去的 4 年中，他接受了 6 次胸部 CT 检查，显示左下叶有不规则形状的肿块样实变（图 1A、B）。4 年前，他接受了支气管镜检查，支气管细胞学检查和支气管冲洗液中细菌、真菌和分枝杆菌的培养结果为阴性。6 个月前的最后一次胸部 CT 显示左下叶实变恶化并伴有支气管扩张（图 1C、D）。不幸的是，他表示他不想进行任何进一步的调查。图 1 患者的系列胸部 CT 成像、血液学、支气管镜和组织学检查结果。(A, B) 4 年前进行的胸部 CT 显示左下叶有不规则形状的肿块样实变。（C，D) 6 个月前进行的胸部 CT 显示病灶内有气道扩大的左下叶实变。（E，F）入院时的胸部 CT 显示左下叶实变恶化，伴有双侧磨玻璃影和左侧胸腔积液。(G) 血清蛋白电泳显示丙种球蛋白水平升高。(H) 血清免疫固定电泳显示 IgM 泳道和 λ 轻链泳道有密集的异常限制区。（我，J）... (H) 血清免疫固定电泳显示 IgM 泳道和 λ 轻链泳道有密集的异常限制区。（我，J）... (H) 血清免疫固定电泳显示 IgM 泳道和 λ 轻链泳道有密集的异常限制区。（我，J）...