INSTRUCTORS ONLY

Respiratory Laboratory 3:
The patient with a lung mass

Slide 63 [WebScope] [ImageScope]

A 74 year old woman presents with a large supraglottic squamous cell carcinoma, for which she undergoes radiation therapy followed by total laryngectomy. She is followed for recurrence by serial CT scans. A 1.2 cm right middle lobe lung nodule is discovered on one of these CT scans. She undergoes a wedge resection of the nodule in order to make a diagnosis.

1. Based on the pathologic features, what is your diagnosis?

2. Structures are present in the cytoplasm of alveolar macrophages. What accounts for these structures?

3. What are some causes of this condition?

4. What are some of the risk factors for aspiration of gastric contents?

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 26 [WebScope] [ImageScope]

A 60-year old man sought medical attention because of weight loss. During his evaluation, the patient also complained of a decreased appetite, weakness, and night sweats. A non-productive cough had recently developed. Physical examination revealed hepatosplenomegaly. A chest x-ray manifested a diffuse nodular infiltrate. Laboratory evaluation disclosed an anemia with leukopenia, and an elevated alkaline phosphatase level. A liver biopsy was obtained for diagnosis, and the patient responded well to treatment. The provided slide is taken from the autopsy of a similar patient.

1. Based on the clinical presentation and the findings contained in the autopsy slide, what diagnoses are most likely?

2. How could you confirm your diagnosis?

3. How does your diagnosis explain the clinical, radiographic, and laboratory findings?

4. What types of social settings increase the risk of infection by the agent responsible for the pathologic features manifested by 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 patient’s 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'