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Suffer from upper lobe lung consolidation and hilar mass. Sputum test shows superficial squamous epithelial cells mixed with basal cells. Help?

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Oncologist, Surgical
Practicing since : 1986
Answered : 59 Questions
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I AM SUFFERING FROM RIGHT UPPER LOBE LUNG CONSOLIDATION AND HILAR MASS.MY CONDITION IS THAT I AM SUFFERING FROM PRONOUNCED SHORTNESS OF BREADTH.MY AGE IS 86.THE TEST RESULTS ARE AS FOLLOWS:1.SPUTUM FOR ACID FAST BASCILLUS: NEGATIVE. 2.SPUTUM FOR CYTOLOGY(MALIGNANT CELLS): SMEARS STUDIED SHOWS SUPERFICIAL SQUAMOUS CELLS ADMIXED WITH BASAL CELLS. BACKGROUND SHOWS MUCOID MATERIAL, MIXED INFLAMMATORY CELLS AND FEW FUNGAL ORGANISMS MORPHOLOGICALLY CONSISTENT WITH CANDIDA SPECIES. NO ATYPICAL CELLS SEEN/NEGATIVE FOR MALIGNANCY.IMPRESSION: INFLAMMATORY SPUTUM SMEAR. 3. VIDEO BRONCHOSCOPY RESULT: FINDINGS; VOCAL CORD-RT VC MOVT-PARALYSEDLT VC WELL COMPENSATED. TRACHEA-NORMAL. CARINA-NORMAL.RIGHT BRONCHUS: MILD NARROWING OF RMB, RULB OPENING TOTALLY OCCLUDED BY THICK SECRETIONS. TOILETING DONE, LATER SCOPE ENTERED RULB, SHOWS C/O GROSS EXTERNAL COMPRESSION WITH THICK MUCOUS PLUG IN ALL SEGMENTAL OPENING. RT INT BRONCHUS NORMAL, MINIMAL SECRETIONS. LEFT BRONCHUS: NORMAL AND MINIMAL SECRETIONS. BAL:RMB. BIOPSY: NIL IMPRESSION: RT VC PARALYSED. EXTERNAL COMPRESSION OR RULB, NO GROWTH SEEN . ADVICED CT SCAN AND GUIDED FNAC IF POSSIBLE. 4.BRONCHIAl waSH:ACID FAST BASCILLI NOT SEEN. SMEARS ARE NEGATIVE FOR MALIGNANT CELLS. 5. CT SCAN REPORT: IMPRESSION: MEDIASTINAL AND HILAR LYMPHADENOPATHY WITH RIGHT UPPER LOBAR EXTENSIVE CONSOLIDATIONS AND WITH LINGULAR SEGMENTAL/RIGHT LOWER LOBAR LARGE PULMONARY NODULES WITH RIGHT SIDED PLEURAL EFFUSION-THE POSSIBILITY OF METASTATIC DISEASE NEEDS TO BE CONSIDERED.6. CT GUIDED FNA:SITE OF ASPIRATION: RIGHT LOWER LOBE LUNG. PATHOLOGICAL DIAGNOSIS: CYTOLOGICAL FEATURES ARE SUGGESTIVE OF GRANULOMATOUS INFLAMMATION OF TUBERCULOUS ETIOLOGY-RIGHT LOWER LUNG. MY QUESTIONS ARE:1. WHEN MY PROBLEM IS IN THE UPPER LOBE OF THE LUNG, WHY DID THEY CONDUCT THE ASPIRATION IN THE RIGHT LOWER LOBE OF LUNG? 2.AS MY DOCTOR IS NOT SATISFIED WITH THE RESULTS, HE HAS ORDERED ANOTHER CT GUIDED FNAC IN A CANCER HOSPITAL WHICH IS SCHEDULED ON 26TH OF SEPTEMBER 2013. WHAT SHOULD I SPECIFICALLY TELL THE FNAC CONDUCTING DOCTORS ? 3. HAVE THEY MISSED ANYTHING IN THE DIAGNOSIS? 4.WHAT ACTUALLY SHOULD BE THE DIAGNOSIS?
Posted Mon, 14 Oct 2013 in Cancer
 
 
Answered by Dr. K. Harish 7 hours later
Brief Answer:
diagnosis could be difficult

Detailed Answer:
The air we breathe goes to lung through windpipe which divides into tubes called right and left bronchii which further sub-divide. Any blockage to any of these small tubes (called bronchioles) result in collapse/consolidation and infection beyond the block. Hence both lung infections and tumors/cancers can present with similar picture. It is difficult many times to diagnose. In addition, infections also result in altered cellular picture and needle aspiration may be reported as 'atypical' cells or 'dysplastic' cells similar to what is seen in cancer.

Having understood the problem in diagnosis because of the organ/disease, you still need to undergo bronchoscopy and / or FNAC to prove the diagnosis. Please be advised that these procedures need to be repeated at times till the diagnosis is obtained. But paralysis of vocal cord and pleural effusion suggest (NOT diagnositc) a possibilty of cancer.

What you have to specifically understand is that the difficulty is inherent with the organ and disease and in NO WAY indicates the incomptency of the doctor. You need to be patient till you obtain a diagnosis. Please also question yourself that since the patient is 86 years old, would you like to subject her to all these tests? If you decide that you are not going to subject her to any major therapy, you should reconsider subjecting her to detailed diagnostic tests.
Above answer was peer-reviewed by
 
Follow-up: Suffer from upper lobe lung consolidation and hilar mass. Sputum test shows superficial squamous epithelial cells mixed with basal cells. Help? 2 hours later
RESPECTED SIR: THANK YOU VERY MUCH FOR YOUR ANSWER AND I HAVE THE FOLLOWING FOLLOW-UP QUESTION AS I AM TAKING MY MOTHER AGAIN FOR THE CT GUIDED FNAC TEST ON 26TH SEPTEMBER 2013:( IN FACT, APART FROM ME, THIS DOUBT HAS ALSO BEEN INDEPENDENTLY EXPRESSED BY THE DOCTOR TREATING MY MOTHER:) THE CT GUIDED FNAC TEST IS TO ANALYSE THE HILAR MASS AND THE CONSOLIDATION AND THESE THINGS HAPPEN TO BE IN THE RIGHT UPPER LOBE OF THE LUNG. WOULD THE RADIOLOGIST CUM DOCTOR HAVE MADE A MISTAKE IN DOING THE CT GUIDED FNAC TEST ON THE LOWER LOBE OF THE RIGHT LUNG INSTEAD OF THE UPPER LOBE OF THE RIGHT LUNG? I NEED ANSWER TO THIS QUESTION SO THAT I CAN SPECIFICALLY ASK THE DOCTOR/RADIOLOGIST TO CONCENTRATE ON THE UPPER LOBE OF THE RIGHT LUNG OF MY MOTHER SO THAT THE TRUTH CAN BE ESTABLISHED WITHOUT ANY MAJOR ERROR.
 
 
Answered by Dr. K. Harish 47 minutes later
Brief Answer:
unlikely

Detailed Answer:
The guided biopsies are reasonably accurate. The doubtful areas seen on the CT imaging are biopsied. Hence there are almost negligible chances of error of site or side occuring. However, for reasons mentioned earlier, a representative area might not be accessed; which is an acceptable possibility.
Above answer was peer-reviewed by
 
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