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5. Video-assisted thoracoscopic resection
While a percutaneous transthoracic needle biopsy could reasonably be repeated, typically when this procedure fails to obtain satisfactory tissue for diagnosis, particularly when the needle is appropriately placed, it is appropriate to escalate to more invasive tissue sampling methods. In this case, open thoracotomy is again a reasonable consideration, but video-assisted thoracoscopic surgery provides a less invasive and typically less costly, approach for selected indeterminate pulmonary nodules. If a diagnosis of primary malignancy is obtained at video-assisted thoracoscopic surgical resection, often the procedure is then converted to an open thoracotomy to allow for formal lobectomy with lymph node sampling to provide definitive surgical therapy for cancer.
The patient underwent video-assisted thoracoscopic wedge resection of the left upper lobe nodule. The histopathological specimen is displayed in Figure 4.
Figure 4. Histopathological specimen: A= Sulfated alcian blue stain; B= Congo red stain with polarized light; C= kappa light chain stain; D= lambda light chain stain.
Which of the following represents the diagnosis for this patient? (Click on the correct answer to proceed to the ninth and final panel)