Case of the Month: March 2023

Clinical history

A 67-year-old patient presented to their family doctor for worsening chronic cough with new onset low volume hemoptysis, fatigue, and weight loss. The patient has a 50-pack-year smoking history. The family doctor orders a chest X-ray, which shows a lobular mass-like opacity in the hilum. The patient was referred to the emergency room for urgent diagnostic work-up. CT scan of the chest showed a large hilar mass with lymphadenopathy. A CT-guided core needle biopsy of the mass was obtained.

How to participate

Take a look at these images from an H&E section of the hilar mass biopsy.

Anyone is welcome to try to solve the puzzle by commenting on the related post on our Instagram.

If you are a medical student at the University of Toronto, you can also:

If you do, you are in for a chance to win a $100 gift card! (UofT Med students only).


Discover the answer to March's case of the month!

The answer to the March Case of the Month is Small Cell Carcinoma. Small cell carcinoma is a poorly differentiated, high-grade neuroendocrine carcinoma that often presents as advanced-stage disease in patients with a long smoking history. The neoplastic cells have scant cytoplasm, hyperchromatic nuclei with smudgy/finely granular chromatin, and lack nucleoli. Tumour cells can often be seen moulding together. Frequent mitotic figures, apoptotic bodies, and areas of necrosis are invariably present. Treatment options include chemotherapy, radiation therapy, and immunotherapy.

The diagnosis and treatment of small cell carcinoma (and most cancers in general), requires a multidisciplinary team. This team includes family medicine and emergency medicine physicians who initiate the diagnostic process, radiologists, pathologists, surgical oncologists, medical oncologists, radiation oncologists, and allied health professionals. Individual cases are often discussed at multidisciplinary rounds to decide on the best course of management for each patient.

Stay tuned for the April Case of the Month, which will be posted mid-April! 

If you are a current medical student at U of T, you can register to join the March case of the month lecture online or in person and have a chance to win a $100 gift card!

If you’re a medical student at the University of Toronto interested in Laboratory Medicine join the Special Interest Group in Laboratory Medicine to be invited to a case of the month lecture (catered).

Laboratory Medicine and the study of disease for medical students

Medical students in the gross lab