{"id":44999,"date":"2025-08-05T14:03:15","date_gmt":"2025-08-05T06:03:15","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=44999"},"modified":"2025-08-05T16:37:13","modified_gmt":"2025-08-05T08:37:13","slug":"thor-2","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thor-2\/","title":{"rendered":"Mystery cases &#8211; Thoracic 2"},"content":{"rendered":"\n<h2>\n\t\tThoracic case 2\n\t<\/h2>\n\t<h1>An obstructing bronchial lesion<\/h1>\n\t<p><strong>Clinical history<\/strong>: A 46-year-old female, non-smoker, presented with shortness of breath. Imaging showed obstructive atelectasis and bronchoscopy revealed a 3.0 cm endobronchial submucosal lesion in the left main bronchus. Fine needle aspiration of the lesion was performed.<\/p>\n<p><em>(Case contributed by: Dr Bibiana Tie, Princess Alexandra Hospital, Brisbane, Australia)<\/em><\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THOR9.jpg\" alt=\"Thoracic case 2\" itemprop=\"image\" height=\"300\" width=\"451\" title=\"THOR9\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THOR10.jpg\" alt=\"THOR10\" itemprop=\"image\" height=\"300\" width=\"451\" title=\"THOR10\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Cytologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<ul>\n<li>Tissue fragments comprising basaloid cells surrounding balls of stromal material\n<ul>\n<li>Cells at periphery and not embedded within stromal material<\/li>\n<\/ul>\n<\/li>\n<li>Cellular uniformity (important feature)<\/li>\n<li>Small cell size with high N:C ratio<\/li>\n<li>Oval to angulated nuclei<\/li>\n<li>Occasional distinct nucleoli<\/li>\n<li>Stippled to coarse nuclear chromatin<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Differential diagnoses<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-1\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<ul>\n<li>Salivary gland-type tumours\n<ul>\n<li>Adenoid cystic carcinoma<\/li>\n<li>Basal cell neoplasm<\/li>\n<li>Myoepithelial neoplasm<\/li>\n<li>Pleomorphic adenoma<\/li>\n<\/ul>\n<\/li>\n<li><strong>Small cell carcinoma<\/strong><\/li>\n<li>Carcinoid tumour<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Histologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-2\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\nA concurrent biopsy of the lesion was also performed.\n<p><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THOR11.jpg\" alt=\"\" \/><\/p>\n<ul>\n<li>Cribriform islands and nests of relatively bland tumour cells<\/li>\n<li>Biphasic uniform epithelial (luminal) and myoepithelial (abluminal) cells<\/li>\n<li>Hyaline stromal material present in pseudolumina<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-3\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-3\">Diagnosis<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-3\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\n<strong>Adenoid cystic carcinoma<\/strong>\n<ul>\n<li>It is particularly important to distinguish high grade\/solid type adenoid cystic carcinoma from small cell carcinoma due to differences in treatment and prognosis\n<ul>\n<li>Similarities\n<ul>\n<li>Occasional sheet-like architecture, seen especially in solid variant of adenoid cystic carcinoma<\/li>\n<li>Small cell size and high N:C ratios<\/li>\n<li>Stippled to coarse chromatin<\/li>\n<li>Nuclear moulding<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Discriminating features which favour small cell carcinoma\n<ul>\n<li>Clinical\u00a0\n<ul>\n<li>Significant smoking history<\/li>\n<li>Higher propensity for nodal metastases<\/li>\n<\/ul>\n<\/li>\n<li>Cytomorphology\n<ul>\n<li>Greater nuclear pleomorphism<\/li>\n<li>Lack of stromal fragments<\/li>\n<li>Indistinct nucleoli<\/li>\n<li>Occasional dirty \/ necrotic background<\/li>\n<\/ul>\n<\/li>\n<li>Immunohistochemistry<\/li>\n<li>\n<ul>\n<li>Positive for TTF1 and neuroendocrine markers (synaptophysin and chromogranin A)<\/li>\n<li>Negative for CD117 and does not demonstrate biphasic luminal\/abluminal cell differentiation<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Reference<\/strong><\/p>\n<p>Kim S, Chu J, Kim H, Han J. Comprehensive Cytomorphologic Analysis of Pulmonary Adenoid Cystic Carcinoma: Comparison to Small Cell Carcinoma and Non-pulmonary Adenoid Cystic Carcinoma. J Pathol Transl Med. 2015;49(6):511-519. doi:10.4132\/jptm.2015.09.07<\/p>\n\t<p><em>Case writer: Dr Noel Chia<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>Thoracic case 2 An obstructing bronchial lesion Clinical history: A 46-year-old female, non-smoker, presented with shortness of breath. Imaging showed obstructive atelectasis and bronchoscopy revealed a 3.0 cm endobronchial submucosal lesion in the left main bronchus. Fine needle aspiration of the lesion was performed. (Case contributed by: Dr Bibiana Tie, Princess Alexandra Hospital, Brisbane, Australia) [&hellip;]<\/p>\n","protected":false},"author":828,"featured_media":0,"parent":44933,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-44999","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thor-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"Thoracic case 2 An obstructing bronchial lesion Clinical history: A 46-year-old female, non-smoker, presented with shortness of breath. Imaging showed obstructive atelectasis and bronchoscopy revealed a 3.0 cm endobronchial submucosal lesion in the left main bronchus. Fine needle aspiration of the lesion was performed. 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