A 48-year-old male with squamous cell lung cancer and metastatic involvement of subcarinal (white arrows) and right lower paratracheal (black arrows) lymph nodes. (A, B) Initial chest computed tomography scan shows subcarinal and right lower paratracheal lymph node enlargement. (C, D) An endobronchial ultrasound image of the subcarinal and right lower paratracheal lymph nodes shows hypoechoic texture, a round shape, and well-demarcated borders. (E, F) The tumor cells formed sheets of hyperchromatic cells with a high nuclearcytoplasmic ratio and focal keratinization. The specimen has a necrotic and hemorrhagic background (H&E stain, ×400). 

Contexts in source publication

Context 1

... 48-year-old male visited our clinic with a 1-month history of cough. He had been healthy and had no specific family his- tory. An initial chest radiograph showed a mass-like lesion in the right lower lung zone, and a subsequent chest computed tomography (CT) scan confirmed a 5.1-cm-sized right lung mass with enlarged lymph nodes at the right hilar, subcarinal, and right lower paratracheal area, which was highly suspected to be primary lung cancer ( Figure 1A, B). Positron emission tomography and magnetic resonance imaging of the brain detected no distant metastasis; therefore, EBUS-TBNA (BF- UC260F-OL8; Olympus, Tokyo, Japan) was performed for both pathologic diagnosis and nodal staging of the suspected lung cancer according to the American College of Chest Phy- sicians evidence-based clinical practice guidelines ( Figure 1C, D) 5 . Ultrasound findings showed that the subcarinal and right lower paratracheal lymph nodes were enlarged (19×21 mm and 10×16 mm, respectively) with discrete margins and central hypoechogenicity. During needle aspiration, lymph node consistency was supposedly soft and tender. Eventually, core tissues with necrotic materials were obtained from the subcarinal and right lower paratracheal lymph nodes. No im- mediate EBUS-TBNA-related complication was detected, and the patient tolerated the procedure well under conscious se- dation. Core tissues obtained from EBUS-TBNA were revealed to be squamous cell carcinoma with extensive necrosis ( Figure 1E, F). Finally, the patient was diagnosed with stage IIIA (T2b- N2M0) squamous cell carcinoma of the lung. He was planned to receive neoadjuvant concurrent chemoradiotherapy but was subsequently considered for curative surgery. For prompt initiation of concurrent chemoradiotherapy, the patient remained hospitalized until the pathologic result of EBUS-TBNA was confirmed. He complained of a burning chest pain with fever of up to 38.9 o C 4 days after EBUS-TBNA. Laboratory examinations revealed that the blood leukocyte count was 15,330/μL with a differential of 79.9% neutrophils (normal range, 40−73%) and C-reactive protein level had in- creased to 5.91 mg/dL (normal range, 0−0.5 mg/dL). A chest radiograph showed normal findings; therefore, a subsequent chest CT scan was performed to identify a suspicious com- plication possibly related to EBUS-TBNA. The chest CT scan showed a significantly increased ill-defined soft tissue density and fluid collection in the mediastinum with an increase in the size of the subcarinal lymph node (Figure 2). The patient was started on empirical antibiotic treatment including piper- acillin/tazobactam and vancomycin for management of the mediastinal infection caused by ...

Context 2

... 48-year-old male visited our clinic with a 1-month history of cough. He had been healthy and had no specific family his- tory. An initial chest radiograph showed a mass-like lesion in the right lower lung zone, and a subsequent chest computed tomography (CT) scan confirmed a 5.1-cm-sized right lung mass with enlarged lymph nodes at the right hilar, subcarinal, and right lower paratracheal area, which was highly suspected to be primary lung cancer ( Figure 1A, B). Positron emission tomography and magnetic resonance imaging of the brain detected no distant metastasis; therefore, EBUS-TBNA (BF- UC260F-OL8; Olympus, Tokyo, Japan) was performed for both pathologic diagnosis and nodal staging of the suspected lung cancer according to the American College of Chest Phy- sicians evidence-based clinical practice guidelines ( Figure 1C, D) 5 . Ultrasound findings showed that the subcarinal and right lower paratracheal lymph nodes were enlarged (19×21 mm and 10×16 mm, respectively) with discrete margins and central hypoechogenicity. During needle aspiration, lymph node consistency was supposedly soft and tender. Eventually, core tissues with necrotic materials were obtained from the subcarinal and right lower paratracheal lymph nodes. No im- mediate EBUS-TBNA-related complication was detected, and the patient tolerated the procedure well under conscious se- dation. Core tissues obtained from EBUS-TBNA were revealed to be squamous cell carcinoma with extensive necrosis ( Figure 1E, F). Finally, the patient was diagnosed with stage IIIA (T2b- N2M0) squamous cell carcinoma of the lung. He was planned to receive neoadjuvant concurrent chemoradiotherapy but was subsequently considered for curative surgery. For prompt initiation of concurrent chemoradiotherapy, the patient remained hospitalized until the pathologic result of EBUS-TBNA was confirmed. He complained of a burning chest pain with fever of up to 38.9 o C 4 days after EBUS-TBNA. Laboratory examinations revealed that the blood leukocyte count was 15,330/μL with a differential of 79.9% neutrophils (normal range, 40−73%) and C-reactive protein level had in- creased to 5.91 mg/dL (normal range, 0−0.5 mg/dL). A chest radiograph showed normal findings; therefore, a subsequent chest CT scan was performed to identify a suspicious com- plication possibly related to EBUS-TBNA. The chest CT scan showed a significantly increased ill-defined soft tissue density and fluid collection in the mediastinum with an increase in the size of the subcarinal lymph node (Figure 2). The patient was started on empirical antibiotic treatment including piper- acillin/tazobactam and vancomycin for management of the mediastinal infection caused by ...

Context 3

... 48-year-old male visited our clinic with a 1-month history of cough. He had been healthy and had no specific family his- tory. An initial chest radiograph showed a mass-like lesion in the right lower lung zone, and a subsequent chest computed tomography (CT) scan confirmed a 5.1-cm-sized right lung mass with enlarged lymph nodes at the right hilar, subcarinal, and right lower paratracheal area, which was highly suspected to be primary lung cancer ( Figure 1A, B). Positron emission tomography and magnetic resonance imaging of the brain detected no distant metastasis; therefore, EBUS-TBNA (BF- UC260F-OL8; Olympus, Tokyo, Japan) was performed for both pathologic diagnosis and nodal staging of the suspected lung cancer according to the American College of Chest Phy- sicians evidence-based clinical practice guidelines ( Figure 1C, D) 5 . Ultrasound findings showed that the subcarinal and right lower paratracheal lymph nodes were enlarged (19×21 mm and 10×16 mm, respectively) with discrete margins and central hypoechogenicity. During needle aspiration, lymph node consistency was supposedly soft and tender. Eventually, core tissues with necrotic materials were obtained from the subcarinal and right lower paratracheal lymph nodes. No im- mediate EBUS-TBNA-related complication was detected, and the patient tolerated the procedure well under conscious se- dation. Core tissues obtained from EBUS-TBNA were revealed to be squamous cell carcinoma with extensive necrosis ( Figure 1E, F). Finally, the patient was diagnosed with stage IIIA (T2b- N2M0) squamous cell carcinoma of the lung. He was planned to receive neoadjuvant concurrent chemoradiotherapy but was subsequently considered for curative surgery. For prompt initiation of concurrent chemoradiotherapy, the patient remained hospitalized until the pathologic result of EBUS-TBNA was confirmed. He complained of a burning chest pain with fever of up to 38.9 o C 4 days after EBUS-TBNA. Laboratory examinations revealed that the blood leukocyte count was 15,330/μL with a differential of 79.9% neutrophils (normal range, 40−73%) and C-reactive protein level had in- creased to 5.91 mg/dL (normal range, 0−0.5 mg/dL). A chest radiograph showed normal findings; therefore, a subsequent chest CT scan was performed to identify a suspicious com- plication possibly related to EBUS-TBNA. The chest CT scan showed a significantly increased ill-defined soft tissue density and fluid collection in the mediastinum with an increase in the size of the subcarinal lymph node (Figure 2). The patient was started on empirical antibiotic treatment including piper- acillin/tazobactam and vancomycin for management of the mediastinal infection caused by ...