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  #1  
Old 02-27-2011
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Microscope Metastatic lung cancer biopsy question

A 54-year-old man dies unexpectedly in a car accident. On autopsy it is found that he has metastatic disease throughout his body. A biopsy from the lung is shown. Which of the following is the correct diagnosis?

Metastatic lung cancer biopsy question-lungbiopsy.jpg
click image to enlarge

A. Bronchial carcinoid
B. Squamous cell carcinoma
C. Bronchioloalveolar carcinoma
D. Large cell carcinoma
E. Bronchial hamartoma
F. Small cell carcinoma
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Old 02-27-2011
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I'm gonna take a stab in the dark and say D...i'm still studying so i could be wrong.
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Old 02-27-2011
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Default D.

I think your stab is right, rahul - I will also say large cell (D), because of the circled cells:

Metastatic lung cancer biopsy question-lungbiopsy2.jpg
click image to enlarge

The one on the lower right might be an artifact or multinucleate, but the center one looks both large and different... Small cell cancer has, well, smaller cells - I think the smaller cells in this slide are inflammatory infiltrate. Definitely no squamous differentiation (B); a hamartoma (E) would be indistinguishable from normal histology at 40x; carcinoid (A) would be a uniform collection of stippled cells, but all close together I think; and bronchioloalveolar carcinoma is a carcinoma in situ, although I guess it might have given rise to this.

Last edited by Mondoshawan; 02-27-2011 at 06:08 PM. Reason: added reasons for not picking other choices
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Old 02-27-2011
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i remember them having giant cells :-)
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Old 02-27-2011
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I guess Large cell Carcinoma
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Quote:
Originally Posted by Mondoshawan View Post
I think your stab is right, rahul - I will also say large cell (D), because of the circled cells:

The one on the lower right might be an artifact or multinucleate, but the center one looks both large and different... Small cell cancer has, well, smaller cells - I think the smaller cells in this slide are inflammatory infiltrate. Definitely no squamous differentiation (B); a hamartoma (E) would be indistinguishable from normal histology at 40x; carcinoid (A) would be a uniform collection of stippled cells, but all close together I think; and bronchioloalveolar carcinoma is a carcinoma in situ, although I guess it might have given rise to this.
Yes its a Large cell carcinoma (choice D)

Mondoshawan, rahul and Taiyakikung are correct.

The image is one typical of large cell carcinoma, which is an undifferentiated cancer that generally metastasizes. The cells are much larger and less differentiated appearing than other lung cancers.

When Mondoshawan answers my qn I have no need to explain more. He always picks the correct ans and gives an excellent explanation. He told me once, he loves Histology.

For others, if you need more info on LCC, please follow the link

http://chemo.net/large.htm

Explanation for other choices

Bronchial carcinoid typically appears as small nests of neuroendocrine cells.

Bronchioloalveolar carcinoma occurs more peripherally and is derived from Clara cells, which spread on the alveolar walls.

Bronchial hamartoma is a benign lesion derived from connective tissue such as adipose or cartilage.

Squamous cell carcinoma generally forms cavitary lesions in the lung and cytoogy is characterized by keratinized squamous cells that stain orange and form cytoplasmic bridges.
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