case_images: PMC5838497_01
case_images: Positron emission tomogram showing mild [11F]-2-fluoro-2-deoxy-D-glucose (FDG) uptake in the right upper lobe lesion (a) (short white arrow), diagnosed as squamous cell carcinoma on biopsy ((b) hematoxylin and eosin, 40x; (c) CK5 immunostain, 40x). (d) A highly FDG-avid left infrahilar mass (long white arrow) that was diagnosed as small cell carcinoma after biopsy analysis ((e) hematoxylin and eosin, 100x; (f) synaptophysin, 100x).
case_images: CRIPU2018-1718326.001.jpg
case_images: PMC5838497_01_CRIPU2018-1718326.001.jpg
case_images: fig1
case_images: TTF-1 markers (Figures 1(a)-1(c)). The LLL consolidation was not sampled during this procedure, as it was located on the contralateral lung, was noted to be stable for 6 months based on a prior chest radiograph, and had been analyzed after a previous bronchoscopy with cytology and transbronchial lung biopsies without evidence of malignancy. A staging positron emission tomogram (PET) done after the navigational bronchoscopy once a malignant diagnosis was confirmed showed FDG avidity in the RUL lesion (SUV 2), along with an FDG-avid left infrahilar mass (SUV 11) within the LLL consolidation (Figure 1(d)). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the left infrahilar mass revealed a cluster of cells with minimal cytoplasm and small nuclei with nuclear cytoplasmic molding (Figures 1(d)-1(f)). CD56, and synaptophysin and negative for p63 and CK5 (Figure 1). The final diagnosis was a right-sided Stage I NSCLC (squamous) and a left-sided limited SCLC. Chemotherapy was initiated with etoposide and cisplatin, along with concurrent radiation for the left-sided SCLC.