Contributed by Laurentia Nodit, MD, Douglas Johnson, MD, Gregorio Remigio MD and Samuel Yousem, MD
Published on line in March 2002
Disclosure Statement: In accordance with the policies on disclosure of the Accreditation Council for Continuing Medical Education and the Faculty Advisory Committee for Continuing Education in the Health Sciences, University of Pittsburgh, presenters for this program have identified no personal relationships with a health care product company which, in the context of their topics, could be perceived as a real or apparent conflict of interest.
The patient was a 46 year-old gentleman with a persistent right lower lobe pulmonary mass after a successfully treated cavitary pneumonia 5 months ago. At the time of presentation he was clinically asymptomatic. The patient worked in the hospital incineration area and smoked one pack of cigarettes a day. He recently quit.
A chest CT scan revealed a right lower lobe lung mass, multiple nodular centrilobular opacities and multiple small cavitary nodules suspicious for tumor in all lobes.
A PET scan identified a focal area of increased lung fluorodeoxyglucose uptake in the right perihilar region that correlated with the mass seen on CT.
The specimens consisted of a right upper lobe wedge resection and a right lower lobectomy. The upper lobe wedge revealed a 0.5 cm, firm, tan-brown, stellate nodule. The lower lobectomy showed a 2.7cm, gray tan, firm, well-circumscribed mass, puckering the pleura, and a slightly emphysematous, background lung parenchyma.