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Very simple. 4R nodule. Ebus.
Biggest I've seen so far( this is not the longest view. ).
Biggest I've seen so far( this is not the longest view. ).
That's a big lymphnode and someone is doing an EBUS. You can't tell much else from the images.
But based on your hint. It's probably a lymphnode full of cocci.
ROSE said looks like lymphoma! And they were all exited about it, and the final path... Small cell.
This was the biggest I've seen so far, in an angle I was able to hub the ebus needle and was nowhere close the end of it( trying to go "edge to edge")
I don't think I've seen a level 4 node that big yet. Though the big nodes with small cell CA from . . . where??? Always make me scratch my head.
Your cytopathologist needs a good beating about the head and neck.ROSE said looks like lymphoma!
Your cytopathologist needs a good beating about the head and neck.
Lymphoma = Big cells
Small cell = Small cells
FWIW, I hate when they try to give a diagnosis on the ROS path. The only thing they should say is "adequate/inadequate" and "malignant/normal/reactive/necrotic". That's it. I've seen too many cases like this where the patient hears "well, we think it might be lymphoma (curable) and then it comes back small cell (really, really not curable) and now I have to walk that back (and take them from "hey, I can cure you" to "hey, you're going to be dead in <2 years" which is always a fun conversation to have). Some of my Pulm folks are good at deferring that discussion, some are not.
Your cytopathologist needs a good beating about the head and neck.
Lymphoma = Big cells
Small cell = Small cells
FWIW, I hate when they try to give a diagnosis on the ROS path. The only thing they should say is "adequate/inadequate" and "malignant/normal/reactive/necrotic". That's it. I've seen too many cases like this where the patient hears "well, we think it might be lymphoma (curable) and then it comes back small cell (really, really not curable) and now I have to walk that back (and take them from "hey, I can cure you" to "hey, you're going to be dead in <2 years" which is always a fun conversation to have). Some of my Pulm folks are good at deferring that discussion, some are not.
Yeah, it was the culture where I trained too. And I hate it. There's no reason a patient can't go home on Tuesday without a diagnosis and see me on Thursday when the path comes back. I've had 3 cases in the last 2 weeks (all GI but the point is still valid) where the patient was told one thing on the way out the door based on prelim path but then had a completely different diagnosis (and most importantly, prognosis) when they walked in my door a day or 2 later. Wait for the data. It makes a difference.And the house team and Onc always likes to push for a preliminary diagnosis so they can d/c soon. It's a culture.
You're the one who sold them hope.Nah. That's what you get for selling hope and then disappearing after they crash and burn with resp failure, kidney failure, and shock in my unit!!!!
You're the one who sold them hope.
I'm not the one with the next and newest magic bag of poison!!!!!!
And molecular studies guided therapy and such! More sample please!!!
We love you Onc docs though.
And molecular studies guided therapy and such! More sample please!!!
We love you Onc docs though.
I don't think I've seen a level 4 node that big yet. Though the big nodes with small cell CA from . . . where??? Always make me scratch my head.
Nah. That's what you get for selling hope and then disappearing after they crash and burn with resp failure, kidney failure, and shock in my unit!!!!
I've seen em get so large you don't see anything on u/s but the mass (they aren't nodes anymore at that point).
And lymphoma off ebus bx is hard, <50% yield. If I suspect, I'll send samples in RPMI to increase yield a little but I see very few lymphomas here.
I'd damn near pay out of my own pocket for a pathologist that can recognize granuloma on a needle aspirate
I'd damn near pay out of my own pocket for a pathologist that can recognize granuloma on a needle aspirate
That's what Tbbx are for
Why? EBUS suppose to have an equivalent yields.
I think you misunderstand. I know the yield data.....my pathologists tried to tell me it wasn't possible.
Most of those young things( I'm in the south, very prevalent) we fna and Tbbx most of the time, we have some cowboy staff that are awesome endoscopists that love mocking using ebus big nodes. Or ebusing sub Carinal nodes, calling you weak.
Lots of fun!
For awhile i was dong both fna & tbbx and still wouldn't get calls from path, so I sadly send my sarcoidosis for meds most the time now