The findings are compatible with primary bronchogenic carcinoma with obstruction of the right lower lobe bronchus, with contralateral mediastinal and supraclavicular nodal involvement, and no signs of distant metastatic disease (T2N3M0).

Tissues should be accessible through bronchoscopy. The left supraclavicular nodes may be technically difficult to access via ultrasound. Completion staging of the upper abdomen and/or FDG PET should be performed.

Bronchoscopy lavage and biopsy were performed: 
1. TBNA sub carina: 3 wet-fixed and 3 air-dried smears prepared. Also received in formalin, multiple small cores of blood clot processed as a cell block. Adequacy statement: Small amount diagnostic material.
2. Bronchial washings: 15 ml of heavily blood-stained fluid.

MICROSCOPIC DESCRIPTION: 1&2. The smears and cell block section show very occasional groups of malignant epithelial cells. The tumor cells have high N/C ratio with enlarged hyperchromatic nuclei, granular chromatin, nuclear molding, occasional conspicuous nucleoli and scant cytoplasm. There are occasional mitoses and apoptotic debris in the background. Immunostains on the cell block from specimen one show the tumor cells are positive for AE1/3, p40 and CK5/6 and negative for CD45 CK7, TTF-1, chromogranin, CD56, synaptophysin and TTF-1. This profile is consistent with a poorly differentiated squamous cell carcinoma.

DIAGNOSIS: 1. TBNA sub carina: Carcinoma, immunohistochemistry consistent with poorly differentiated squamous cell carcinoma. 
2. Bronchial washings: Carcinoma.