Presentation
Presented with left hip pain and left foot swelling. Smoker with 6 months of cough and 2 months of weight loss. Hoarse voice for 6 months and dysphagia for 2 months.
Patient Data
Mediastinal widening and opacification in the left upper zone.
Cavitating abnormality at the left lung apex.
Massive mediastinal adenopathy with associated small pericardial effusion and some adjacent atelectasis of left upper lobe.
The left main bronchus is compressed.
The esophagus is obstructed.
Focal metastatic lesion in the right 11th rib.
Case Discussion
The clinical picture and CXR is highly suggestive of a primary lung malignancy with mediastinal lymphadenopathy.
The patient became significantly hypoxic so underwent CTPA to investigate for potential pulmonary embolism (PE). There was no PE but instead massive mediastinal lymphadenopathy causing compression of the left main bronchus.
Subsequent core biopsy confirmed small cell carcinoma.
Histology
MICROSCOPIC
The sections show multiple small fragments of a cellular neoplasm, much of
which is necrotic. There is a small amount of residual viable tumor, in
perivascular locations, which is composed of cells with pleomorphic,
hyperchromatic oval nuclei with speckled chromatin and indistinct cytoplasm.
There is marked crush artefact.
A series of immunohistochemical stains show that the tumor cells are:
Positive: AE 1/3, CD 56
Negative: Chromogranin, synaptophysin
Ki-67 stains greater than 50% of nuclei in the well preserved areas.
The features are consistent with a small cell carcinoma.
SUMMARY: Mediastinal mass, core biopsies: SMALL CELL CARCINOMA.
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