Cytologically Yours: CoW: 20131118

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Contents

Clinical History

The patient is a 49 year old male who was found to have an enlarging nodule in the right lower lobe on CT scan. The nodule was first identified in March of 2013 and a repeat CT scan in June 2013 showed it had increased in size from 1.4 cm in greatest dimension to 2.0 cm in greatest dimension. The patient denied fever, chills, and weight loss.

Past Medical History

  • Coronary artery disease stats post coronary artery bypass grafting in 2008
  • Hypertension
  • Hyperlipidemia
  • Immunosuppression
  • Depression
  • Chronic obstructive pulmonary disease
  • Gastroesophageal reflux disease
  • Berger disease
  • No known history of malignancy

Past Surgical History

  • Living unrelated kidney transplant in 2012 for Berger disease (with immunosuppression)

Social History

Retired elevator mechanic with a history of asbestos exposure.

Medications and Allergies

Crestor, Imitrex, Nexium, Prograf, Labetalol

Allergy to Chlorhexidine, tape and Temazepam

Radiology

CT Findings: No definite adenopathy. Nodule in right lower lobe has increased in size from 1.4 x 0.9 cm to 2.0 x 1.2 cm.

Pathology

Cytology


Resident Questions


Biopsy Histology

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Final Diagnosis

Cytology

  • Mucinous neoplasm present. This is a peculiar lesion consisting of mucinous atypical cells and pools of mucin. Consider low-grade mucinous neoplasm. Differential diagnosis includes bronchiolo-alveolar carcinoma vs. primary mucinous neoplasm of the lung vs metastasis from elsewhere.

Biopsy

  • Mucinous adenocarcinoma (bronchioloaveolar carcinoma, mucinous type).

Case Discussion

This is a classic cytology and histology of a mucinous adenocarcinoma of the lung.