Presentation
Shortness of breath in a heavy smoker with chronic obstructive lung disease (COPD).
Patient Data
Large right-sided pleural effusion, probably with component of atelectasis, as the mediastinum and heart are not displaced contralaterally.
The pleural fluid was drained partially, so as not to induce re-expansion edema - exudate.
Large mass with necrotic foci at the right lung hilum, measuring 10.5 x 11.2 x ~20 cm (including a direct extension in the right lower lobe (RLL)). The mass insinuates into the posterior mediastinum, compressing the left atrium and esophagus; surrounds and compresses and the right pulmonary veins; compresses the arteries to the right middle lobe (RML) and RLL; compresses and focally occludes the RML and RLL lobar bronchi, as well as segmental and subsegmental bronchi, and mildly compresses the right upper lobe (RUL) bronchus. Complete RML collapse. Large RLL consolidation and interstitial thickening in rest of lobe. Large right pleural effusion.
Massive mediastinal lymphadenopathy involving many stations; a portion of the enlarged lymph nodes are contiguous with the pulmonary mass. Substantial right hilar and mild left hilar lymphadenopathy.
Several non-enlarged pancreaticoduodenal and peripancreatic lymph nodes.
Homogeneous mass in pancreatic body measuring 2.7 x 2.9 x 2.4 cm - primary mass? Metastasis?
A 450 ml sample of pleural fluid was sent for histology:
A few groups of neuroendocrine features present, suspicious for SCLC.
Immunostains: CK7, MOC31, CK8/18, CD56 and TTF1positive. Calretinin, desmin, chromogranin, synaptophysin, P40 negative.
Follow-up PET-CT done 3.5 months later, after several doses of chemotherapy, shows significant regression of the primary mass and outstanding regression of the mediastinal-bihilar lymphadenopathy. The RML is still collapsed.
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