Correct
5. More than one of the above
The presence of a bloody pleural effusion, a potential right lower lobe parenchymal lesion, and the suspicious intraoperative frozen section findings are all concerning for malignancy, but not specific for any one particularly source. Hence, malignancies commonly affecting the pleural space, including bronchogenic malignancy and metastases, merit consideration. Even mesothelioma remains a possibility as that malignancy can result in unilateral pleural effusions without nodular pleural thickening. An occult abscess, perhaps aspiration-related, with a right pleural space parapneumonic effusion is also still a possibility.
Pathological analysis of the right pleural biopsies (Figure 5) showed fibrinous pleuritis with atypical cells and mixed inflammatory cells.
Figure 5. Histopathological specimen from thoracoscopic pleural biopsy (Hematoxylin & Eosin, 40x) shows fibrinous pleuritis.
In situ hybridization showed a polytypic population of cells. CD3 and CD20 highlight small T and B lymphocytes. BCL-6 highlights a few small germinal centers. BCL-2 showed no coexpression in the BCL-6 positive cells. CD21 highlighted multiple foci of follicular dendritic cell meshworks. HHV8 was negative. Pankeratin and GATA3 disclosed no evidence for a malignancy. No evidence of amyloid was present.
The patient recovered eventually following her thoracic surgery procedure but re-presented less than 1 month later with complaints of shortness of breath, fatigue, and failure to thrive. Chest radiography (Figure 6) was performed.
Figure 6. Frontal chest radiography performed less than one month following thoracoscopic surgical pleural biopsy shows a moderate-sized right pleural effusion.
Which of the following statements regarding this chest radiograph is accurate? (Click on the correct answer to be directed to the twelfth of seventeen pages)