Department of Pathology, University of Oklahoma Health Sciences Center
A 60 year-old, asymptomatic man with multiple nodules in the lung and mediastinal lymphadenopathy.
Clinical information: The patient was an asymptomatic, 60 year-old smoking male with a past history laryngeal cancer, status-post chemo- and radiation therapy. He was followed in the clinic for evidence of cancer recurrence. About one year ago, the patient was found to have a distinct coin lesion in the right upper lung lobe and multiple, small to minute, diffuse pulmonary nodules bilaterally. The base of the lung was relatively spared. Mediastinal lymphadenopathy was also demonstrated. A chest CT showed similar findings. An FNA was carried out for suspicion of malignancy on a pleural based nodule but the specimen has only non-diagnostic changes. The patient continued to be followed with chest CTs which demonstrated an increase in number of lung nodules, stable mediastinal lymphadenopathy and an interval development of interstitial fibrosis. He remained asymptomatic. A suspicion of infectious etiology was considered, although malignancy could not be ruled out. A tuberculin test was negative. A wedge biopsy obtained from the right upper lobe lung was performed. The followings are representative images of the biopsy material.
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Cases of the Month Coordinator: KarMing-Fung@ouhsc.edu