Presentation
Shortness of breath in a smoker.
Patient Data
Large right pleural effusion extends to the level of the 2nd rib anteriorly. Left lung remains clear.
There is a fairly large right pleural effusion. This has caused almost total collapse of the right lung. A pleural mass is no appreciated. No pleural thickening is demonstrated. The distal aspect of the right lower lobe bronchus is collapsed. Aeration of a part of the right upper lobe is seen. No mediastinal abnormality.
Case Discussion
This is a case of a 75-year-old male who presented to our hospital with a three month history of worsening shortness of breath and reduced exercise tolerance. He described a 25kg weight loss and had a 65-pack-year history of smoking.
This gentleman underwent a pleuritic tap which confirmed malignant adenocarcinoma.
MACROSCOPIC:
- Received 50ml of cloudy yellow fluid with clots.
MICROSCOPIC:
- Moderate cellularity
- Malignant cells are present in a background of leukocytes (predominantly lymphocytes), histiocytes and blood
- Malignant cells have markedly pleomorphic, hyperchromatic nuclei and moderate amounts of cytoplasm
IMMUNOHISTOCHEMISTRY:
- Positive: AE1/3, CEA, TTF1
- Negative: BerEp4, calretinin, WT1, CK5/6
Features are consistent with metastatic adenocarcinoma of pulmonary origin.
He has now been referred to medical oncologists for ongoing treatment.
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