Residency Program - Case of the Month

Clinical history:

The patient is a 33-year-old Caucasian female with no significant past medical history who presented with a chief complaint of progressive shortness of breath over a course of 3 months. Additionally, she described dyspnea on exertion, mild cough, and 30lb weight loss. Her physical exam was notable for decreased left lung sounds. A CT of her chest (figure 1) revealed a large partially necrotic mass, centered on the left hilum and superior segment of the left lower lobe. After core needle biopsy of the mass and mediastinal lymph node sampling, she subsequently underwent a left pneumonectomy. The pneumonectomy specimen submitted to pathology is described below.

Gross description:

The left pneumonectomy specimen (figure 2) was notable for a large 9 x 8 x 7.5 cm  circumscribed mass located centrally between the upper and lower lobes near the left bronchus. The tumor grossly involved the parenchyma of both the upper and lower lobes. On sectioning the tumor had a tan, fleshy cut surface with areas of necrosis. The tumor did not appear to grossly involve the bronchial airways. The pleural surface was smooth.

H and E Slides:

Microscopically the tumor showed varying histologic patterns (figures 3-8) with the predominant pattern shown in figures 3-5.

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