Which of the following additional histologic findings is most likely to be present on his biopsy?
A 44-year-old man with a history of chronic alcohol abuse has lost 6 kg in the past five months. He has had a cough with hemoptysis along with pleuritic chest pain for the past 2 weeks. On physical examination his temperature is 37.5 C. A chest radiograph reveals a bilateral reticulonodular pattern of infiltrates. A transbronchial biopsy is performed and on microscopic examination shows epithelioid cells with necrotic debris. Laboratory studies show a WBC count of 5890/microliter with 78% granulocytes, 15% lymphocytes, and 7% monocytes.
A. Branching, septated hyphae B. Pleomorphic cells with dark, angular nuclei C. Clusters of small RBC-sized cysts staining with GMS D. Small, rounded hyperchromatic cells with a high N/C ratio E. Acid-fast bacilli
Acid fast bacilli -(e) correct. the hemoptysis suggests that the granulomas have eroded enough parenchyma and involved a bronchus. a granulomatous reaction is typical for mycobacterium tuberculosis.(a) incorrect. aspergillus infection is not common. it is more likely to produce a fungus ball. persons who are neutropenic are at greatest risk. the inflammatory reaction could vary from acute to mixed to granulomatous.(b) incorrect. a squamous cell carcinoma is usually a central mass lesion. it is unlikely that epithelioid cells would appear on biopsy(c) incorrect. pcp in rare cases has a granulomatous pattern, but the granulomas would be small and unlikely to lead to hemoptysis.(d) incorrect. small cell anaplastic carcinomas are centrally located. they are unlikely to be found with epithelioid cells.