Review Question - QID 109917

A 68-year-old man is seen by his primary care provider for several weeks of chest pain, shortness of breath, and a chronic cough that has recently developed. The patient has been healthy his entire life and does not take any medications aside from a daily multivitamin and occasional ibuprofen for headaches. On further questioning, the patient has worked in construction and renovation but has most recently worked in a managerial position for the last 20 years. He has a history of smoking 1 pack per day for 15 years but quit smoking 30 years ago. He does not drink alcohol and runs 3 times a week. The patient's family history is only significant for hypertension and myocardial infarction in his father at age 70. The patient’s temperature is 98.8°F (37.1°C), blood pressure is 124/68 mmHg, pulse is 78/min, and respirations are 13/min. On exam, he has dullness to percussion at the base of his right lung and slightly decreased air movement on the right side. The patient’s cardiac exam is unremarkable, and all cardiac studies are within normal limits. On further workup, the patient has radiographic features that are concerning for malignancy and is referred for a tissue biopsy. The tissue specimen is seen in Figure A. Which of the following is the most likely cause of this patient’s symptoms?