Nodule Diseases

Question 1

Sarcoid/Chronic Beryllium Disease

Answer 1

• well-formed nonnecrotizing granulomas
• concentric collagen deposition
• lymphatic distribution (near vessels, airways, and pleura)

Question 2

Pulmonary langerhans’ cell histiocytosis (PLCH)/Eosinophilic granuloma (EG)

Answer 2

Cellular phase

• langerhan’s histiocytes (CD1a/S100 positive)
• variable inflammation including eosinophils

Fibrotic phase
- stellate scar around airway

• usually smoking related if lung limited

Young smokers
Imaging: cysts and nodules
Upper lobe predominant
Mixed PFTs
PTX common
15% extrapulm dz—including  bone lesions, pituitary  involvement
Treatment is smoking cessation

Question 3

carcinoid

Answer 3

• nests and ribbons of neuroendocrine cells with powdery salt-and-pepper chromatin
• stain positive for neuroendocrine markers (chromogranin, synaptophysin, CD56)
• usually indolent but may act in malignant fashion particularly if there is nuclear atypia, high mitotic rate or necrosis

Question 4

Small cell carcinoma

Answer 4

• small blue easily-crushed cells with scant cytoplasm
• stain positive for neuroendocrine markers (chromogranin, synaptophysin, CD56)
• high mitotic rate and abundant necrosis
• very aggressive

Question 5

squamous cell carcinoma

Answer 5

• large polygonal cells with hyperchromatic (dark) nuclei and abundant cytoplasm
• rarely have prominent nucleoli
• may be keratinizing and form keratin pearls

Question 6

adenocarcinoma

Answer 6

• cells with large nuclei, large nucleoli, and variable amounts of cytoplasm
• form gland-like structures
• adenocarcinoma in situ: cells only line septa and do not invade

Question 7

Large cell carcinoma

Answer 7

large, sometime bizarre-appearing malignant cells that lack typical features of either adenocarcinoma or squamous cell carcinoma