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Respiratory Laboratory 3:
The patient with a lung mass


Reading Assignments (Robbins: Pathologic Basis of Disease)
8th Edition 7th Edition
723 - 727 759 - 762
729 - 730 764 - 765
732 - 734 768 - 770
   

Slide 74 [WebScope] [ImageScope]

A 59-year old man sought medical attention because his chronic cough had become more severe and was interfering with his sleep. He had also noted that his sputum was occasionally blood-streaked. His subsequent evaluation demonstrated a 3 centimeter mass near

  1. Please classify this neoplasm.

  2. What is the etiology of most lung carcinomas?

  3. What other signs and symptoms may be associated with lung carcinomas?

  4. What extrapulmonic sites are at risk for harboring metastatic foci from this neoplasm?

  5. Perhaps the most common spirometric abnormality related to non-small cell lung cancer itself is a restrictive impairment. What clinical features may account for this?

 

Slide 75 [WebScope] [ImageScope]

A 55-year old woman sought medical attention because of shortness of breath and left sided chest pain. Clinical evaluation revealed a left-sided pleural effusion that was tapped. A follow-up chest x-ray demonstrated a non-calcified mass in the periphery of the left upper lobe. A portion of the effusion was analyzed in the cytopathology laboratory where a diagnosis of malignancy was rendered. Based on this information, this patient was treated with chemotherapy. Following a short-lived response to therapy, the patient deteriorated and died 4 months later. The slide shows one of several histologic variations of this neoplasm.

  1. How do you classify the neoplasm?

  2. How do pleural effusions form in patients with lung cancer?

  3. What might have been the appearance of the effusion fluid?

  4. What molecular diagnostic testing may have been useful in this patient?



Slide 28 [WebScope] [ImageScope]

During his evaluation for progressive proximal muscle weakness and fatigability, a lung nodule was detected in a 44-year-old man. The nodule was subsequently resected, and the muscle weakness gradually improved.

  1. What are the pathologic features of this neoplasm?

  2. This type of neoplasm may produce ectopic hormones. Give some examples of other syndromes produced by such hormone production.

  3. What is the usual form of treatment for this tumor?

  4. What is thought to be the etiology of the muscle weakness?



Slide 73 [WebScope] [ImageScope]

This lesion was resected from the lung of a 28-year old man who had complained of occasional hemoptysis. His health had otherwise been excellent and he was a nonsmoker. Based upon the pathologic features, how would you classify this neoplasm?

  1. Assuming the neoplasm was completely resected and that there was no evidence of metastatic spread, predict this patientís prognosis.

  2. What might have been the bronchoscopic appearance of the lesion?

  3. What are some of the associated signs and symptoms?

  4. From what type of cell may this neoplasm have originated?

 

The answers to the path lab questions will be posted approximately 48-72 hours after the lab sessions. These are abbreviated answers, not a full discussion of the topics. You can find them in the M2 CTools site resources. In the folder for each sequence the will be a folder called 'Path Lab Resources'


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