Lung Tumors

Question · easy

A 45-year-old never-smoker with no other risk factors has an incidental 4-mm solid pulmonary nodule on chest CT. Prior imaging is unavailable for comparison. According to the 2017 Fleischner Society recommendations, what is the most appropriate next step?

CT-guided transthoracic needle biopsy No follow-up is required Repeat chest CT at 6-12 months PET/CT scanning

Question · easy

Which of the following patients meets USPSTF criteria for annual lung cancer screening with low-dose CT?

An 84-year-old asymptomatic man with a 40-pack-year history who currently smokes A 68-year-old asymptomatic man with a 25-pack-year history who quit smoking 8 years ago A 72-year-old asymptomatic woman with a 15-pack-year history who currently smokes A 65-year-old asymptomatic man with a 30-pack-year history who quit smoking 20 years ago

Question · medium

A 64-year-old man with a 50-pack-year smoking history presents with chronic cough, hemoptysis, and recurrent right middle lobe pneumonia. Chest CT shows a hilar mass with lobar collapse. Biopsy is most likely to show which histologic pattern?

Sheets of small neuroendocrine cells with TP53 and RB1 inactivation Glandular differentiation with mucin production Keratinization and intercellular bridges Large undifferentiated cells with prominent necrosis in a peripheral mass

Question · medium

A patient with newly diagnosed small cell lung cancer has disease confined to one hemithorax with ipsilateral supraclavicular lymph node involvement. How is this disease best classified, and why does this distinction matter?

Extensive-stage disease, because any nodal involvement above the diaphragm defines extensive disease Limited-stage disease, but only if mediastinal nodes are spared Limited-stage disease, because it can be encompassed within a tolerable radiation port, permitting concurrent chemoradiation Stage IVB disease only, because SCLC is staged exclusively with the TNM system

Question · hard

A 71-year-old retired insulation worker presents with progressive dyspnea and nonpleuritic chest pain. Imaging shows unilateral pleural thickening and a recurrent exudative pleural effusion. Pleural fluid cytology is negative for malignant cells. Which statement regarding diagnosis and prognosis is most accurate?

The suspected diagnosis is malignant pleural mesothelioma; cytology alone cannot establish it, and thoracoscopic pleural biopsy (>90% sensitivity) is required The findings most likely indicate benign asbestos pleural effusion because latency for mesothelioma is under 5 years Negative cytology effectively excludes mesothelioma, so observation is appropriate Pleural mesothelioma is diagnosed by PET imaging alone, and median survival exceeds 5 years with current therapy