Table of Contents Author Guidelines Submit a Manuscript
TheScientificWorldJOURNAL
Volume 11 (2011), Pages 760-765
http://dx.doi.org/10.1100/tsw.2011.74
Case Study

Approach to Multiple Pulmonary Nodules: A Case Report and Review of Literature

1Wollongong Hospital, Wollongong, NSW, Australia
2Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
3Illawara Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, Australia

Received 12 January 2011; Revised 18 February 2011; Accepted 1 March 2011

Academic Editor: Klaus Kayser

Copyright © 2011 Farshid Niknam et al.

Abstract

Chest X-ray and CT examinations often find pulmonary nodules that could be malignant or benign. A case is presented and discussed here in order to improve diagnosis and management of pulmonary nodules. A 62-year-old lady was found to have multiple pulmonary nodules by X-ray when she complained of a cough and fever. This was confirmed by a CT scan. Fine needle aspiration (FNA) of one of the lung lesions reported scant atypical epithelial cells that stained positive for TTF-1 and cytokeratin 7, but negative for cytokeratin 20. Thus, it was suspicious for large cell carcinoma. A videothoracoscopic lung biopsy and histopathology were applied and showed a necrotic nodule with surrounding chronic inflammation and macrophage response, with no evidence of malignant cells. Atypical reactive pneumocytes at the periphery of the lesion (an old infarct) were probably equivalent to the atypical cells seen on cytology. This result changed the diagnosis of our patient from a malignant condition to a benign process. Thus, CT and FNA may give a false positive. A second pathological opinion is very useful for the right diagnosis and management, as shown in our case.