Question

A 56-year-old woman has smoked 2 packs a day for the last 30 years. She has had a chronic cough for the past 8 years but recently has noted increased sputum production. On physical examination, she has a few crackles auscultated best over the lung bases. Bronchoscopy with biopsy is performed. The biopsy reveals bronchial epithelium with squamous metaplasia. Which of the following statements represents the best interpretation of these findings?

Option 1: Precancerous changes in the bronchial epithelium.
Option 2: Chronic obstructive pulmonary disease (COPD).
Option 3: Tuberculosis infection.
Option 4: Pulmonary fibrosis.

Answer 1

The biopsy showing bronchial epithelium with squamous metaplasia in the context of this patient's heavy smoking history and symptoms most likely indicates precancerous changes in the bronchial epithelium.

Step-by-step explanation:

The biopsy revealing bronchial epithelium with squamous metaplasia in a 56-year-old woman who has smoked 2 packs a day for the last 30 years and presents with a chronic cough and increased sputum production suggests the best interpretation of these findings is Option 1: Precancerous changes in the bronchial epithelium. Squamous metaplasia is a process where normal columnar epithelial cells are replaced by squamous cells, which can be a response to chronic irritation from smoking and it is a potentially precancerous transformation. Considering her smoking history and these specific biopsy results, it is important to monitor this condition as it may progress to squamous cell carcinoma. Option 2: Chronic obstructive pulmonary disease (COPD) is also associated with smoking, but the particular finding of squamous metaplasia specifically leans towards precancerous cellular changes. Tuberculosis and pulmonary fibrosis are not typically associated with such cellular transformations.