Bronchial tumor: Surgery or a second opinion?

A few years back, my father battled tuberculosis, and just about two months ago, he ended up hospitalized with pneumonia and some very concerning suspicions that the TB might have resurfaced. While they managed to clear the infection with antibiotics, the bronchoscopy results were quite unsettling:

" ... a tumor was found in the third segment of the right bronchus. The pathologists haven't provided a definitive diagnosis regarding the specific type of tumor yet. I would suggest proceeding with a CT scan of the chest and upper abdomen."

The CT findings indicate:

".....adjacent to the right bronchi, the posterior and anterior segments show solid tissue interspersed with calcifications of varying sizes, which most likely corresponds to post-specific cicatricial changes. There is mild bronchial dilation and displacement of the horizontal interlobar fissure, which appears to be a consequence of the described scarring. Similar changes in extent, location, and appearance are visible in the left upper lobe, accompanied by somewhat more pronounced bronchiectasis ...."

Now, if I am interpreting this correctly—and I am certainly no medical expert—it seems there is a glaring contradiction here; the CT scan appears to show nothing more than scar tissue resulting from his previous bout with TB, whereas the bronchoscopy explicitly identified a tumor.

The pulmonologist is currently recommending surgery, but we are feeling incredibly hesitant, given that he is 64 years old and the potential complications associated with a procedure of this magnitude are always a significant concern.

Should we go ahead and consent to the surgery, or would it perhaps be more prudent to request a repeat bronchoscopy or seek out a second opinion first?

Thank you, and best regards!

Ronald Anderson93 said:A few years back, my dad fought TB, and about two months ago, he was hospitalized with pneumonia and concerns that the TB might have flared up again. They cleared the infection with antibiotics, but the bronchoscopy results were concerning:

" ... dark mass found in the right third segment bronchus. Pathologists cannot provide a definitive diagnosis regarding the tumor type. Suggesting a CT scan of the chest and upper abdomen."

The CT findings show:

".....along the right bronchi, the apical posterior and anterior segments show solid tissue interspersed with calcifications of varying sizes, most likely representing post-specific cicatricial changes. Mildly dilated bronchi and a pulled horizontal interlobar fissure, seemingly as a consequence of the described scarring. Similar changes in extent, location, and appearance are visible in the left upper lobe alongside slightly more pronounced bronchiectasis ...."

Now, looking at this through a layman's eyes, the CT seems to point toward nothing but scarring left behind by the TB, yet the bronchoscopy flagged a tumor.

The pulmonologist is recommending surgery, but we’re hesitating because he’s 64, and there are always risks involved with an operation like this.

Should we go ahead with the surgery, or would it be better to redo the bronchoscopy or seek a second opinion?

Thanks and best regards!

It might be wise to repeat the bronchoscopy—basically, you need a definitive pathology report.
If the man is generally healthy and doesn't have major heart issues, surgery at that age shouldn't be as risky as the danger posed by leaving that tumor inside him.
You'll need to sit down with the doctor and weigh all the pros and cons, then let your dad make his own choice based on that, without any outside pressure.

Ronald Anderson93 said:A few years back, my father dealt with TB, and about two months ago, he ended up in the hospital with pneumonia and fears that the TB had resurfaced. They managed the infection with antibiotics, but the bronchoscopy results were concerning:

" ... dark tumor found in the third bronchial segment on the right side. Pathologists cannot provide a definitive diagnosis regarding the specific type of tumor. I recommend a CT scan of the chest and upper abdomen."

The CT findings:

".....on the right side along the bronchial application, both posterior and anterior segments show solid tissue sporadically interspersed with calcifications of varying sizes, which most likely corresponds to post-specific cicatricial changes. Mildly dilated bronchi and an attracted horizontal interlobar fissure appear to be consequences of the described scarring. Similar changes in extent, location, and appearance are visible in the upper lobe on the left, accompanied by somewhat more pronounced bronchiectasis ...."

Now, as much as I can make sense of this as a layman, the CT report seems to point toward nothing but scar tissue resulting from the old TB, yet the bronchoscopy explicitly flagged a tumor.

The pulmonologist is pushing for surgery, but we are hesitating. He’s 64, and let's face it—complications from a procedure like this are always a massive risk.

Should we pull the trigger on the surgery, or would it be smarter to redo the bronchoscopy or hunt down a second opinion?

Thanks in advance!

It would be incredibly helpful if you could provide the full reports rather than just these snippets.
If I were in your shoes, I'd definitely get that bronchoscopy repeated first.

Ronald Anderson93 said:My dad dealt with TB a few years back, and about two months ago he ended up in the hospital with pneumonia and fears that the TB was resurfacing. They treated the infection with antibiotics, but the bronchoscopy showed this:

" ... finding a dark tumor in the third bronchus on the right. Pathologists can't provide a definitive answer regarding the specific type of tumor. I suggest a CT scan of the chest and upper abdomen."

CT results:

".....along the right bronchi, the posterior and anterior segments show solid tissue intermittently interspersed with calcifications of varying sizes, which most likely corresponds to post-specific cicatricial changes. Mildly dilated bronchi and an attracted horizontal interlobar fissure, all seemingly as a result of the described scarring. Similar changes in extent, location, and appearance are visible in the upper lobe on the left, along with slightly more pronounced bronchiectasis ...."

So, from what I can gather as a layman, the CT shows nothing but scarring from the old TB, yet the bronchoscopy flagged a tumor.

The pulmonologist is pushing for surgery, but we're hesitating because he's 64 and there are always risks involved with procedures like this.

Should we go ahead with the surgery, or should we redo the bronchoscopy or just get a second opinion?

Thanks and cheers!

What did the pathologists actually write down? They had to put something in writing for you to be able to transcribe it. Look, you can always redo the bronchoscopy with a different PhD, or you can hunt for a second opinion at a different hospital system. Bottom line: without a PhD, you don't have a diagnosis. A CT scan is basically useless when it comes to identifying the actual type of tumor. It’s just used to gauge how far things have spread once the process is already proven.