Correct!
5. Flexible fiberoptic bronchoscopy
Performing follow up CT is a common management approach for indeterminate lung nodules, but in the context of recurrent Cushing syndrome, a lung nodule, particularly one apparently associated with an airway, merits immediate assessment. 18FDG-PET scanning would not be contributory in this circumstance- active tracer uptake would prompt a tissue diagnosis (which is needed anyway), and negative results would not be useful. Furthermore, the nodule is rather small for 18FDG-PET assessment. Repeat somatostatin scintigraphy could be of benefit, strongly indicating the presence of an ACTH-secreting tumor given the patient’s Cushing syndrome if positive, but negative results would be non-contributory. Furthermore, somatostatin scintigraphy is most useful for localizing a site of ectopic ACTH production, and now that an airway-associated nodule has been identified at CT, further management should be directed at obtaining a tissue diagnosis. 18FDG-PET MR plays little role in the evaluation of lung nodules and would not be appropriate in this circumstance.
The patient underwent flexible fiberoptic bronchoscopy (Figure 9).
Figure 9. Bronchoscopy of the left lower lobe anterior basal segmental airway lesion.
Which of the following findings at biopsy would be least consistent with the clinical behavior and bronchoscopic appearance? (Click on the correct answer to be directed to the twelfth and final page)