Pathology Case Study 4

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A 64-year-old male factory worker presented with a history of chest pain and hemoptysis. He had lost more than 3 kg in weight in the last four weeks and complained of feeling “run down and having no energy”. He had smoked heavily since adolescence. The only relevant past history was a squamous cell carcinoma of the larynx three years previously, which had been treated with surgery and radiation. Physical examination revealed a cachectic, nervous man with decreased breath sounds on the right side of the chest. An x-ray demonstrated a large right upper lobe mass with central cavitation. CT scans indicated that the mediastinal nodes were enlarged. Sputum cytology revealed a moderate number of metaplastic and dysplastic squamous cells, and rare malignant cells. Laryngoscopy indicated no evidence of recurrence of his original tumor. Bronchoscopy revealed several thickened white areas, which were biopsied and a large polypoid mass obstructing the right upper lobe bronchus. Examination of the mediastinum, using a special instrument, was performed and an enlarged node was biopsied. He received radiation therapy to the chest, but his condition deteriorated and he died four months later. An autopsy was performed.

  1. Discuss the clinicopathologic correlation of this case.
  2. Give your differential diagnosis
  3. What is the most likely diagnosis?
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