Archive for the ‘Small-Cell Carcinoma’ Category

In all five of our patients (Table 1), the forceps biopsy specimens of an endobronchial small-cell carcinoma were nondiagnostic due to either extensive mechanical crush artifact (cases 1, 2, 4, and 5) or to sampling error (case 3). The concurrently obtained cytologic specimens were all nondiagnostic, with the exception of a transtracheal needle aspirate (case 1) and a bronchial wash of borderline adequacy (case 4). The tendency of small-cell carcinoma to undergo crush artifact when sampled by the forceps biopsy technique is well recognized in the surgical pathology literature.” While the presence of crush artifact in an endobronchial forceps biopsy is strongly suggestive of small-cell carcinoma, other entities, such as benign lymphoid infiltrates and lymphoma, may exhibit similar distortion. Hence, a definitive diagnosis of small-cell carcinoma cannot be rendered on crush artifact alone. The propensity of small-cell carcinoma to show crush artifact may be related to a number of factors, including increased cell fragility, scanty cytoplasm, poorly developed desmoplastic response to tumor, altered cellular attachments, and possibly, myofibroblast contraction.Canadian family pharmacy read only The alteration in cellular attachments, as reflected in decreased cellular cohesion, may actually contribute to an increased yield by EBNA sampling. In this regard, Schenk et al have previously noted a significantly higher yield of TBNA in patients with small-cell carcinoma. This finding could not be accounted for solely by the propensity of this neoplasm for bulky mediastinal nodal involvement, and seemed to reflect an increased amenability of this tumor type to diagnosis by this technique.
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Endobronchial Needle Aspiration in the Diagnosis of Small-Cell Carcinoma: DiscussionA 77-year-old man presented with a history of increasing dyspnea, malaise, weight loss, and dry cough over the preceding months. Chest radiograph and computed tomography demonstrated a large peripheral right lower lobe mass with hilar and mediastinal adenopathy. Bronchoscopy revealed extensive submucosal involvement of the right middle and lower lobe bronchus with tumor nodules protruding through the mucosa. Bronchial washings, brushings, and transcarinal needle aspirate were negative for tumor. The forceps biopsy specimen showed crush artifact. A diagnosis of small-cell carcinoma, intermediate variant, was rendered on the EBNA specimen.

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Case 1
A 49-year-old man presented with a 3-month history of cough and intermittent fever. The chest radiograph revealed left perihilar fullness and left upper lobe opacification. Computed tomography scan confirmed a 6.5X7.0-cm hilar mass with associated volume loss of the left lung. Bronchoscopy demonstrated an exophytic endobronchial tumor in the apical posterior segment of the left upper lobe.
Endobronchial washing, brushing, biopsy specimens, and paratracheal TBNA were all nondiagnostic. The forceps biopsy specimen exhibited a mechanically distorted cellular infiltrate, ie, “crush artifact.” Because of the high clinical suspicion of carcinoma, bronchoscopy was repeated and EBNA of the left upper lobe endobronchial lesion was performed. The EBNA specimens were diagnostic for small-cell undifferentiated carcinoma. The concurrent bronchial washing and brushing as well as multiple endobronchial forceps biopsy specimens were again nondiagnostic. A repeated transtracheal needle aspirate was also positive.
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Endobronchial Needle Aspiration in the Diagnosis of Small-Cell Carcinoma: MethodsSince its introduction by Wang et al in the early 1980s, transbronchial needle aspiration (TBNA) via the fiberoptic bronchoscope has become a valuable adjunct in the evaluation of patients with lung cancer. The utility of TBNA in assessing mediastinal adenopathy and in staging lung cancer has been well documented.” Additionally, TBNA has been shown to increase diagnostic yield in patients with submucosal or peribronchial tumors, and it can be used to sample peripheral masses with the help of fluoroscopy.” By contrast, the role of endobronchial needle aspiration (EBNA) in the diagnosis of endobronchial masses is less well defined; forceps biopsy remains the preferred method of pathologic evaluation of these lesions. Buy inhalers online Source It has been suggested that needle aspiration of endobronchial masses is useful primarily in avoiding bleeding from friable lesions. However, we have recently noted several instances in which EBNA of exophytic masses played a definitive role in establishing a diagnosis of small-cell carcinoma. We describe five patients who had obstructing endobronchial masses in whom forceps biopsy specimens were nondiagnostic due to crush artifact (four cases) or sampling error (one case). In three cases, all other cytologic specimens were nondiagnostic; in one, a transtracheal needle aspirate was also positive; and in a fifth case, a concurrent bronchial wash of borderline adequacy was interpreted as positive after comparison with the EBNA material.
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