Presentation
Tachycardia and pyrexia.
Patient Data
12cm left upper lobe mass with 2nd rib destruction.
Right lung clear.
Old right 6th rib fracture.
12cm left upper lobe mass infiltrating the second left rib.
No lung metastases. No mediastinal lymphadenopathy.
Liver cysts.
14G core biopsy of left upper lobe mass undertaken.
13cm left upper lobe mass with 2nd rib destruction.
No post procedure pneumothorax.
SPECIMEN(s) Lung Biopsy,
CLINICAL DETAILS: Left upper lobe mass Likely lung neoplasia, type?
MACROSCOPY: Two needle cores the largest measuring up to 15 mm SB/EP
MICROSCOPY: This is highly fragmented lesional tissue, that consists of dominant necro-inflammatory elements, interspersed with polygonal, epithelioid neoplastic cells. These cells, present dissociated, have round-ovoid to pleomorphic nuclei, with prominent nucleoli. Mitotic activity is seen. Immunomarkers label the neoplastic cells as epithelial - these mark for AE1-AE3 and CK7. These do not express TTF1 and CK5-6. LCA marking of the background leukocytes is seen.
SUMMARY Left lung biopsy: Dominant necro-inflammatory and associated CK7+ carcinoma cells. If this be a lung primary the morphology will be in-keeping with a poorly differentiated non-small cell carcinoma. Careful clinical and radiological correlation is recommended.
Case Discussion
A large lung cancer illustrating that not all lung biopsies need to be undertaken under CT guidance.
CT biopsy typically involves more time, more people, more hassle than an ultrasound biopsy and is truly dynamic.
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