Cough and hemoptysis in a middle-aged woman.

onstrated that the orifice and lumen of the right middle lobe bronchus were significantly obstructed by an irregular mass ( fig. 2 ). There were no mediastinal or pleural abnormalities. Bronchoscopy revealed a large gray mass subtotally obstructing the right middle lobe bronchus ( fig. 3 ). This was biopsied without incident. Histopathological examination showed sheets of spindle-shaped, pleomorphic cells having vesicular nuclei, prominent nucleoli, and brown cytoplasmic pigment ( fig. 4 ). Radiography of the ulna, radius, tibia, and fibula revealed periosteal membrane thickening and periosteal new bone formation ( fig. 5 ). A Tc-99m MDP bone scan showed increased uptake in the periosteal regions of long bones and osteoarthritis of extremities ( fig. 6 ). What Is Your Diagnosis? Case Presentation