Presentation
Presented in ED with intense dyspnea.
Patient Data
Multiple pulmonary nodules bilaterally scattered. There is a large pleural mass with well-defined limits on the right chest lateral midzone, measuring up to 13 cm in its larger axis. Small pleural effusion on the left. Cardiomediastinal contours are otherwise unremarkable. No evidence of pneumothorax or subphrenic free gas.
There are innumerable soft tissue lesions in both lungs, with some extending into the adjacent pleura. The largest is located in the right middle zone, has ill-defined central areas of hyperdensity. It extends into the right lateral thoracic wall, with permeative bone destruction in the right 3rd and 4th ribs. On the left, there is a large loculated pleural effusion causing compression of the interposed left lower lobe. Two bulky adrenal lesions probably represent further metastases. Bilateral hydronephrosis. Within the limits of a noncontrast study, the imaged portions of the liver, gallbladder and spleen are unremarkable. No evidence of bony metastasis.
Case Discussion
Advanced, metastatic lung cancer with likely distant adrenal metastases, pleural involvement and right chest wall invasion. Likely T4,N2,M1b.
MICROSCOPIC DESCRIPTION: The smears contain scattered malignant cells occurring singly, in groups and occasional large loose clusters, in a background of scattered degenerate malignant cells, pulmonary macrophages, acute inflammatory cells and acellular debris. The malignant cells are large with a pleomorphic hypochromatic chromatin pattern, prominent nucloli and abundant foamy cytoplasm.
DIAGNOSIS: Sputum: Undifferentiated large cell carcinoma.
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