Presentation
Scapular and chest pain, opacity on chest X ray. Heavy smoker.
Patient Data
Mediastinal lymphadenopathy, lymph nodes up to 13 mm thick.
Bilateral upper lobe centrilobular pulmonary emphysema.
In the lingula, there is a soft tissue mass measuring 11.0 x 8.5 x 9.0 cm that undergoes irregular enhancement, mostly peripheral, with areas of central necrosis. The mass involves the hilum and splays its vessels, infiltrates the superior anterior mediastinum, abutts the pericardium and has wide contact with the anterior costal pleura. It also obstructs the lingular bronchus.
The adrenals appear normal.
Degenerative changes in the right shoulder (partially included in the scan).
In summary:
Large, necrotic lingular mass, involving adjacent structures.
Mediastinal lymphadenopathy.
Emphysema.
Case Discussion
Pathology report:
Macroscopic:
4 white cylinders of tissue measuring 0.3-1.0 cm in length and 0.1 in diameter, plus several pieces measuring 0.1-0.2 in diameter, as well as tiny fragments.
Microscopic - diagnosis:
Consistent with fragments of partly necrotic squamous cell carcinoma. The tumour cells were strongly and diffusely positive for CK5/6, p40 (squamous cell markers) and p16.
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