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Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Residency Program - Case of the Month

November 2012 - Presented by Kali Tu, M.D.

Clinical history:

The patient is a 27yr old male with a recent history of recurrent pneumonia (5 times over the past two years).  Each episode of pneumonia was diagnosed and treated in ER but reportedly no convalescent chest radiograph was ever performed. The patient has a history of smoking cigarettes 1.5 PPD x 2 yrs and quite in 2011. He complains of a chronic cough productive of green sputum and blood up to a teaspoon, right sided chest pain that is constant and increases with cough, low grade fevers, night sweats, anorexia, weight loss, nocturnal cough, dyspnea at rest, dyspnea on exertion but can walk long distances, fatigue, malaise, and wheezing. The patient has been exposed to tuberculosis, but has had negative PPDs. There is no asbestos exposure, weight gain, anginal chest pain, pedal edema.

 

Work up:

A chest CT scan from an outside hospital shows a right main bronchus tumor with subtotal occlusion, right upper lobe collapse, and mediastinal adenopathy.

The patient has had previous bronchoscopies (at an outside hospital) which were nondiagnostic.  He presents to UC Davis for further evaluation.

A bronchoscopy was performed which identified a tumor in the proximal right main bronchus occluding the bronchus.  The tumor appeared to emanate from the right upper lobe and extend down the right bronchus intermedius posteriorly and laterally.  The distal right bronchus intermedius was free of tumor but inflamed and erythematous.  Biopsies were taken for routine pathology

 

Images:

Case of the Month, Nov. 2012: Microscopic images - 3.2x   Case of the Month, Nov. 2012: Microscopic images - 10x   Case of the Month, Nov. 2012: Microscopic images - 20x   Case of the Month, Nov. 2012: Microscopic images - 20x 2

 

Special stains: 

   

CK5

Case of the Month, Nov. 2012: Special stains - CK5
 

CK7

Case of the Month, Nov. 2012: Special stains - CK7
 

HMB45

Case of the Month, Nov. 2012: Special stains - HMB45

NapsinA

Case of the Month, Nov. 2012: Special stains - NapsinA
 

pas

Case of the Month, Nov. 2012: Special stains - PAS
 

pasD

Case of the Month, Nov. 2012: Special stains - PAS D

p63

Case of the Month, Nov. 2012: Special stains - p63
 

RCC

Case of the Month, Nov. 2012: Special stains - RCC
 

TTF1

Case of the Month, Nov. 2012: Special stains - TTF1

 

ANSWER