“Inflammation is the body’s attempt at self-preservation,” Pontieri wrote. “But when dysregulated, it becomes a slow fire.”

Pathophysiology of neoplasia , she thought. Tumor microenvironment. Paracrine signals gone rogue.

Under the microscope, the alveolar architecture was gone. In its place: sheets of atypical epithelial cells with hyperchromatic nuclei—like dark, angry seeds. But what struck her most wasn’t the tumor itself. It was the stroma: a dense, desmoplastic reaction, as if the lung had tried to wall off the invader with scar tissue.