Correct!
5. All of the above except 2
Again, either percutaneous fine needle aspiration biopsy or bronchoscopy with transbronchial biopsy could be performed for this patient, and both would offer a reasonable likelihood for obtaining a diagnosis. In the context of a repeat procedure, however, if percutaneous sampling is pursued, core biopsy should be performed, with or without, fine needle aspiration biopsy. A video-assisted thoracoscopic procedure is now appropriate, despite its more invasive nature than either percutaneous sampling or bronchoscopy, given that a previous percutaneous tissue sampling procedure has been performed already and did not successfully obtain a diagnosis for this patient. A mini-thoracotomy still remains needlessly invasive at this point. Ultimately, the choice of procedure in this circumstance must be carefully weighed and depends on a balance between procedural risk tolerance, available expertise, and patient / physician preference.
The patient underwent repeat transthoracic percutaneous fine needle aspiration and core biopsy (Figure 4), which showed an infiltrate of plasma cells within a fibrous background. Immunostains showed positivity for DC138 and kappa light chain restriction, and the plasma cells stained positively for cyclin D1.
Figure 4. Histopathological specimen obtained from core biopsy shows plasma cells embedded within a background fibrous stroma. Immunostaining shows positive staining for kappa, but not lambda, light chains.
Which of the following is the most likely consideration for the patient’s condition given the data thus far? (Click on the correct answer to proceed to the ninth and last panel)