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Indiana Association 
of Pathologists, Inc.
Histology Laboratory, Indiana Medical History Museum 

November 2015 Case of the Month

A 53 year-old woman with a lung mass, right hilar mass and mediastinal adenopathy.

Contributed by: 

Rasha Salama, M.D.,

 IU Department of Pathology and Laboratory Medicine Residency Program, PGY-3


Melissa Randolph BS, CT (ASCP), Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN

Howard Wu M.D.Clinical Associate Professor, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine



Clinical History: A 53 year-old woman with a long history of tobacco use was found to have a lung mass on CT measuring 3.5 x 4.2 x3.8 cm which extends back to the hilum. There is also an associated large right hilar mass and mediastinal adenopathy. Fine needle aspiration of the hilar lymph node was performed.

Figure 1. Cohesive group of atypical cells with abundant granular eosinophilic cytoplasm (Giemsa stain, original magnification 400x)



Figure 2. Cells with abundant granular cytoplasm, central nuclei and prominent nucleoli ((Papanicolaou stain, original magnification 400x)

Figure 3. Cell block showing atypical cells with abundant eosinophilic cytoplasm and prominent nucleoli forming glands. Some appear to have intracytoplasmic mucin. (Hematoxylin and Eosin, original magnification 400x)

Figure 4. Cell block (Hematoxylin and Eosin, original magnification 400x)

Figure 5. Cytoplasmic staining With TTF-1 (Original magnification 400x)

Figure 6. Strong cytoplasmic positivity for Cytokeratin 7(Original magnification 400x)

Figure 7. Strong, positive granular cytoplasmic staining with Hep Par 1 (Original magnification 400x)


Figure 8. Negative immunostaining with Glypican-3 (Original magnification 400x)

Figure 9. Negative immunostaining with Arginase-1( Original magnification 400x)


Figure 10. Negative immunostaining with alpha-fetoprotein (AFP)(Original magnification 400x)

AFP serum level was not provided in our case.

Molecular Studies: The specimen was sent for molecular studies and revealed positive KRAS p.G12D mutation.

Diagnosis and Discussion


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