case_images: PMC10870810_01
case_images: Case 1: (a) Computed tomography image shows a right hilar mass associated with adjacent ground glass opacity. (b) The subcarinal node is enlarged with a short axis of 16.9 mm (c) Cell block shows aggregates of tumour cells entrapped within fibrin clot (40x magnification). (d) Solid sheets of tumour cells with increased nuclear: cytoplasmic ratio, vesicular chromatin texture, prominent nucleoli and a modest amount of eosinophilic cytoplasm with indistinct border, in keeping with poorly differentiated carcinoma (400x magnification) seen on cell block. (e) Cryobiopsy specimen sheets of tumour cells (40x magnification). (f and g) Immunohistochemical staining of cryobiopsy specimens shows positive TTF-1 and Napsin A.
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case_images: Computed tomography (CT) thorax revealed a right hilar mass measuring 3.8 x 3.8 x 2.8 cm and mediastinal lymphadenopathy [Figure 2(a) and (b)]. Both the EBUS-TBNA cell block and cryobiopsy sample confirmed adenocarcinoma and were sufficient for mutational analysis, confirming an EGFR (Exon19 deletion) mutation [Figure 2(c)-(g)] Following lung cancer multidisciplinary discussion, she was commenced on gefitinib and responded well to the treatment.
case_images: PMC10870810_02
case_images: Case 2: (a and b) Computed tomography images show mediastinal lymphadenopathy (enlarged station 7 node), left lower lobe segmental collapse and left-sided pleural effusion (c) Cell block (40x magnification) shows cohesive clusters of pleomorphic cells. (d) CK 7 positive from the cell block. (e) Moderately pleomorphic cells with mitosis seen from cryobiopsy specimens (40x magnification). (f and g) ER and PR positivity were seen on cryobiopsy specimens.
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case_images: Follow-up CT thorax revealed mediastinal lymphadenopathy, left lower lobe segmental collapse and left-sided pleural effusion [Figure 3(a) and (b)]. Both EBUS-TBNA cell block [Figure 3(c) and (d)] and EBUS-TBNC sample showed adenocarcinoma of the breast in origin but only the EBUS-TBNC sample was sufficient for hormonal biomarkers analysis, confirming a HER2 negative, ER and PR-positive tumour [Figure 3(e)-(g)].
case_images: PMC10870810_03
case_images: PMC10870810_04
case_images: Case 4: (a and b) Computed tomography images show mediastinal lymphadenopathy (enlarged lymph node stations 4 R, 4 L and 7). (c) Cell block from station 7 lymph node shows benign lymphocytes. No granuloma seen (10x magnification). (d and e) Cryobiopsy specimens from the station 7 node show multinucleated giant cells of Langerhans type, necrotic debris and granulomas (20x magnification). (f) Acid-fast bacilli visualized on Ziehl-Neelsen's staining confirming tuberculosis (40x magnification).
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case_images: AFB direct smears were negative and thoracocentesis revealed an exudative, lymphocyte-predominant effusion with negative culture, cytology, AFB smear, and ADA of 4.18 IU/L. A CT thorax showed right upper lobe nodules, right segmental middle lobe collapse, mediastinal lymphadenopathy and a new left-sided pleural effusion [Figure 4(a) and (b)]. Cell block analysis from TBNA showed benign lymphocytes from station 11 L and station 7 [Figure 4(c)]. However, EBUS-TBNC showed extensive caseous necrosis with aggregates of epithelioid histiocytes, multinucleated giant cells of Langerhans type mixed with necrotic debris and degenerated inflammatory cells [Figure 4(d) and (e)]. Furthermore, Ziehl-Neelsen staining confirmed the presence of acid-fast bacilli [Figure 4(f)], leading to the initiation of anti-tuberculous therapy for the patient.