A 56 year old male has had a chronic cough for many years, but in the past few days has noticed that the sputum contains streaks of blood. He has also gained about 10 kg in the past two months, mostly evident as truncal obesity. On physical examination, you palpate firm, enlarged lymph nodes in the cervical region. His liver also seems to be enlarged.
Abdominal striae are present and the abdomen is enlarged, but without a fluid wave.
Describe the appearance. These cells are not very large. The off-white mass extends irregularly along the bronchovascular tree. There is no single large well-circumscribed mass. There are sheets of small blue cells with no features of normal pulmonary cells.