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Lung Cancer |

Unusual Presentation of a Common Lung Cancer

Khawaja Rahman*, MD; Zia Rehman, MD; Abid Butt, MD; Mark Bowling, MD
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East Carolina University, Greenville, NC


Chest. 2012;142(4_MeetingAbstracts):596A. doi:10.1378/chest.1383510
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Abstract

SESSION TYPE: Cancer Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Lung cancer is the most frequent cause of major cancer incidence and mortality worldwide. Adenocarcinoma is the most common histological subtype of lung cancer in most countries accounting for almost half of all lung cancers. It usually presents as consolidation or mass on chest radiography. We present a patient with adenocarcinoma of lung with multiple nodules on chest CT.

CASE PRESENTATION: 75 year old male was referred to pulmonary clinic for evaluation of an abnormal CT scan of chest and subsequently got admitted. He has been having complaints of cough productive of white phlegm for 6 months accompanied with dypsnea. He had no complaints of hemoptysis, fever, chills or night sweats. Patient has 20 lb unintentional weight loss in 1 year. Patient had history of positive PPD 20 years ago but repeat one was negative. His brother was diagnosed and treated for TB at that time. He had history of 30 pack years of smoking and worked as a refinery operator. His labs were unremarkable. Patients CT chest revealed extensive nodular opacities throughout both lungs greatest through the lung bases. These appear more confluent involving the posterior right lower lobe. Mild underlying changes of centrilobular and paraseptal emphysema and mediastinal and hilar adenopathy was also present. Sputum for AFB was negative. Bronchoscopy was performed which did not reveal any endobronchial lesion. Transbronchial biopsy did not show any pathology, but brushings and BAL revealed malignant cells. FNA of Right Para tracheal lymph node showed malignant cells consistent with adenocarcinoma, cellblock showed positive staining with CK7 and TTF while it was negative for CK 20 and P 63 suggesting primary lung cancer. CT head revealed metastatic disease.

DISCUSSION: This was a unique presentation of adenocarcinoma of lung in the form of multiple nodules on chest CT without any evidence of consolidation or lung mass, which has not been reported in literature. He was found to have stage IV cancer.

CONCLUSIONS: The aim of this report is to alert clinicians and radiologist to the possibility of unusual presentation of adenocarcinoma of lung.

1) Travis WD, Brambilla E et al. International association for the study of lung cancer/American thoracic society/European respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thoracic Oncology. 2011 Feb; 6(2):244-85.

2) Kodama K, Higashiyama M, Yokouchi H, et al. Prognostic value of ground-glass opacity found in small lung adenocarcinoma on high-resolution CT scanning. Lung Cancer 2001; 33:17-25.

3) Lee HY, Han J, Lee KS, et al. Lung adenocarcinoma as a solitary pulmonary nodule: prognostic determinants of CT, PET, and histopathologic findings. Lung Cancer 2009; 66:379 -385.

DISCLOSURE: The following authors have nothing to disclose: Khawaja Rahman, Zia Rehman, Abid Butt, Mark Bowling

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East Carolina University, Greenville, NC

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