case_images: PMC5030447_01
case_images: CT scan of the thorax demonstrating necrotic paratracheal node. Enhanced axial CT scan of the thorax, mediastinal window, in a 58-year-old female who presented with bilateral vocal cord immobility of unknown etiology. The positive serum anti-Hu antibody, which is highly associated with small cell lung carcinoma, led to this repeat CT scan. The arrow demonstrates an enlarged level 4R paratracheal lymph node with central necrosis. See Figure 2 for the pathologic description of a biopsy from this node.
case_images: CRIOT2016-2868190.001.jpg
case_images: PMC5030447_01_CRIOT2016-2868190.001.jpg
case_images: fig1
case_images: A repeat CT scan of the thorax was performed, which demonstrated a new necrotic level 4R paratracheal lymph node (Figure 1).
case_images: Representative cytology slides of paratracheal lymph node. Cytology of endobronchial ultrasound guided fine needle biopsy from the necrotic mediastinal lymph node in Figure 1. Hematoxylin and eosin stain of cell block section (a) demonstrated crowded, overlapping groups of malignant cells in a background of necrosis. Immunohistochemistry was positive for TTF-1 (b), AE-1/AE-3, perinuclear dot-like positivity (c), synaptophysin (d), chromogranin (e), and CD56 (f), confirming the diagnosis of small cell lung carcinoma.
case_images: CRIOT2016-2868190.002.jpg
case_images: PMC5030447_01_CRIOT2016-2868190.002.jpg
case_images: fig2
case_images: An endobronchial ultrasound guided biopsy of this node confirmed the diagnosis of small cell lung cancer (SCLC) (Figure 2).