Correct!
2. Consider left lower lobe surgical resection
Thoracic surgery was consulted for possible left lower lobe resection. Given that the patient is already on extensive broad-spectrum anti-bacterial and anti-fungal treatment, yet the cavity has progressed in size and the patient’s symptoms continue to worsen and no additional potential infectious etiologic agents have been recovered following extensive investigations, continuing the current course of therapy is ill-advised. The previous bronchoscopic procedure was successful and provided data that made a number of differential diagnostic considerations unlikely; repeating the procedure is therefore unlikely to provide additional, management-altering information. Thoracoscopic resection of the left lower lobe is certainly feasible, although thoracoscopic biopsy, short of complete left lower lobe resection, would provide difficult given the size of the left lower lobe cavity. Percutaneous transthoracic needle biopsy could be considered but is sometimes avoided with cavity lung lesions due to a perceived higher risk of complications, and the likelihood that percutaneous transthoracic needle biopsy would add additional information to that already obtained through bronchoscopy is low. Left lower lobe resection would be both diagnostic and therapeutic for this patient.
The patient underwent video-assisted thoracoscopic left lower lobe resection. The histopathologic specimen from this procedure is shown in Figure 4.
Figure 4. Histopathological specimen: A and B= Hematoxylin and eosin stains. C and D= Grocott-Gomori's (or Gömöri) methenamine silver stain.
Which of the following statements is most accurate regarding interpretation of the histopathologic specimen? (Click on the correct answer to proceed to the eighth and final panel)