Gross Features: A biopsy from the lingula contained multiple, homogeneous, firm nodules about 0.5 cm in diameter.

A

Histologic features are shown (images A and B).

Which diagnosis is now most likely?

B

Sarcoidosis

Neoplasm

Infectious granuloma

Clinical summary Image 2

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Answer: Neoplasm

Histologic Features

A

A low-power view of a nodule shows a lobulated, sparsely cellular mass adjacent to a bronchovascular bundle (A = arteries, B = bronchiole). The lobulated appearance is a result of tumor growth into alveolar spaces without destroying the architecture. Note that there is little compression of the surrounding lung tissue.

B

The residual alveolar walls are better seen in B (arrows). These alveolar septa are hyalinized, having undergone coagulative necrosis. The tumor cells, singly and in groups of several cells, are widely separated and compressed by a bluish chondromyxoid (chondroid = homogeneous blue; myxoid = loose pink to blue) matrix.

Clinical summary Image 2

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