Lung squamous cell carcinoma

Case contributed by Dr Bruno Di Muzio

Presentation

Previously well patient. Acute presentation with fever and shortness of breath.

Patient Data

Age: 75-year-old
Gender: Male

Chest radiograph

Modality: X-ray

There is a complete consolidation of the right upper lobe with some ill-defined lucencies within. The remainder of the right lung and left lung are clear. No pleural effusions.

CT Chest

Modality: CT

Cavitating and confluent consolidation is present within the right upper lobe. Possibility of the presence of mass lesion is difficult to completely exclude and evaluation with follow-up imaging once the consolidation has cleared is suggested. Mediastinal lymph nodes are present and these are likely reactive.

Chest radiographs (5 days later)

Modality: X-ray

Extensive consolidation in the right upper lobe associated with a large cavity with a fluid level is unchanged when compare with study from 3 days earlier. The remainder of the lungs are clear.

CT Chest (6 months later)

Modality: CT

There is a 2.3 cm, rounded, lobulated, irregular soft tissue mass in the right upper lobe. It lies centrally in the region of the resolved cavitating pneumonia previously seen in the right upper lobe. No further pulmonary masses are identified. There is no hilar nor mediastinal lymphadenopathy and no evidence of pleural effusion. 

Case Discussion

The follow-up CT performed six months later the acute presentation showed a suspicious appearing lobulated soft tissue mass in the upper lobe and right lung. Appearances were suspicious for a primary lung carcinoma, which was further confirmed bronchoscopically. The patient was submitted then to a partial lobectomy.

MICROSCOPIC DESCRIPTION: Sections of lung show a 24mm maximum dimension well circumscribed, non-encapsulated tumour composed of irregular sheets and cords of atypical polyhedral cells with marked nuclear pleomorphism, prominent nucleoli and abundant cytoplasm in a desmoplastic stroma. No keratinisation is identified. A prominent endobronchial component completely obstructs airways. The visceral pleura is not involved. There is extensive necrosis, frequent mitoses and perineural invasion. No vascular invasion is identified. Tumour is >12mm from the bronchial resection margin. A single anthracotic hilar lymph node shows no evidence of malignancy. The pale nodule described away from the tumour is a subpleural area with alveolar spaces expanded by foamy macrophages and isolated multinucleated giant cells without granuloma formation. The lung parenchyma uninvolved by tumour shows emphysema and anthracosis. Immunohistochemistry: CK5/6 : positive p63: positive Napsin A: negative TTF1: negative CK7: negative CK 20: negative CDX-2: negative

DIAGNOSIS: Right upper lobe: Squamous cell carcinoma. - 24mm maximum dimension. - Poorly differentiated. - AJCC stage IIa (pT1b pN1 Mx). - Perineural invasion present. - Clear of resection margins. - Metastatic to one of 17 lymph nodes. 

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Case Information

rID: 48394
Case created: 5th Oct 2016
Last edited: 10th Dec 2016
System: Chest
Tag: rmh
Inclusion in quiz mode: Included

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