Case 1060 - A Female Patient in Her 50's with Shortness of Breath

Daniel Martinez MD, and Paul Ohori MD


The patient is a 54-year-old female presenting with shortness of breath, malaise, and cough.

Initial chest CT scan demonstrated an infrahilar soft tissue mass with compression of the left lower lobe bronchus and resulting atelectasis of the medial basilar segment (See Figure 1). PET-CT scan demonstrated an SUV of 1.28 (non-hypermetabolic) in the lesion.

Initial bronchoscopic biopsy demonstrated a neoplastic proliferation of cytologically bland cells with squamoid, mucinous and intermediate differentiation (See Figure 2)

The patient underwent photodynamic therapy and bronchoscopic debridement of the lesion. A follow-up CT scan demonstrated significant regression of the left hilar mass with improvement of the left lower lobe bronchus obstruction. A pneumonectomy was performed.

Gross examination of the pneumonectomy specimen demonstrated that the tumor was arising in the distal left main bronchus with polypoid intraluminal bronchial extension. (See Figure 3)

Microscopically, the mass was found to be arising in the submucosa of the left lower lobe bronchus with exophytic extension into the bronchial lumen and involvement of the distal left main bronchus (see Figure 4A). The mass was re-demonstrated to be formed by a proliferation of cells with squamoid, intermediate, and mucinous differentiation (See Figure 4B).

Immunohistochemical and special studies performed demonstrated the tumor cells to be positive for PASD, mucicarmine, and focally positive for P40 (See Figure 5).


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