Presentation
Most likely infective exacerabation COPD. Also right sided chest pain.
Patient Data
The right upper zone is now completely opaque with volume loss - elevation of the horizontal fissure and tracheal deviation to right. Pathcy opactiy in the right lung base.
Complete collapse of the right upper lobe with right-sided volume loss. The right upper lobe bronchus is truncated at its origin. Mediastinal lymphadenopathy (right paratracheal and pretracheal nodes). Background of centrilobular emphysema.
The patient proceeded to bronchoscopic biopsy.
Histology:
MACROSCOPIC DESCRIPTION: "Right upper lobe lesion": Several pieces of rubbery to firm tissue 22 x 15 x 3 mm in aggregate.
MICROSCOPIC DESCRIPTION: The sections show fragments of bronchial mucosa, bronchial wall including cartilage and muscle. Two fragments show infiltrative tumor composed of irregular cords and nests of cells with hyperchromatic nuclei, and with focal unambiguous squamous differentiation including single dyskeratotic cells, intercellular bridges and abundant eosinophilic cytoplasm. Mitotic figures and apoptoses are frequent. There is ulceration and necrosis.
DIAGNOSIS: Right upper lobe lesion biopsies: Poorly differentiated squamous cell carcinoma.
Case Discussion
This is a classic exam case of right upper lobe collapse from an obstructing lung cancer.
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