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July Case of the Month

Clinical History: A 70-year-old male with adenocarcinoma in the left upper lobe. Intraoperatively an abnormality was identified on the visceral surface of the left lower lobe that was suspected intraoperatively to represent an ipsilateral metastasis of the lung cancer. An upper lobe lobectomy and wedge of the left lower lobe lesion was performed. The upper lobe demonstrated an acinar predominant adenocarcinoma. A nodular area was identified in the lower lobe and representative hematoxylin and eosin stained photomicrographs of the lesion are shown in figure 1-3. The lesion was negative for Congo Red but demonstrated strong bright crimson red staining on a Masson Trichrome (figure 4). A comparison composite is presented in figure 5 with different histochemical stains. A clonal Kappa expressing population of plasma cells was identified (figure 6). Electron microscopy demonstrated osmiophilic material forming aggregates of granular electron-dense deposits adjacent to entrapped collagen fibers (figure 7). Subsequent bone marrow and further work up did not demonstrate a systemic plasma cell neoplasm. Note: Non-relevant clinical history may have been omitted or altered to protect patient privacy.

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