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Lung Cancer |

Bulky Locally Invasive Adenocarcinoma of Lung Presenting With Hiccups in an HIV Patient

Ameer Rasheed*, MD; Viswanath Vasudevan, MD; Farhad Arjomand, MD
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The Brooklyn Hospital Center, Brooklyn, NY


Chest. 2012;142(4_MeetingAbstracts):562A. doi:10.1378/chest.1389797
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Abstract

SESSION TYPE: Cancer Case Report Posters II

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

INTRODUCTION: Lung cancer risk is 3 to 4 times higher in HIV-infected patients than in uninfected persons Adenocarcinoma is the most common cell type and commonly presents with peripheral solitary nodule with early invasion of pleura and metastasis to the brain. The majority of HIV patients present at advanced stages of lung cancer. HIV patients have a worse outcome to therapy. We present a unique case of adenocarcimoa presenting as bilobular mass projecting from hilum.

CASE PRESENTATION: A 63 years old AA male with PMH of HIV presented with hiccups and chest discomfort for three days. The chest discomfort was over the left pericardial region. Air entry was reduced and there was dullness to percussion over left chest. Leukocytosis was seen on labs. Chest X-ray showed a large mass lesion on the left upper lobe. CT chest showed a large hypodense mass filling the upper half of the hemithorax, partially encasing the hilum with mass effect upon the left bronchovascular structures and in contiguity with a bulky left paratracheal lymph node. Mass appeared bilobular projection measuring 10.5x17cm on the left upper lobe. CT guided transthoracic needle biopsy histopathology and immunohistochemistry showed poorly differentiated adenocarcinoma. He received palliation radiotherapy.

DISCUSSION: Lung cancer is the most prevalent non-AIDS-defining malignancy. The major features of these patients include: male gender, young age, a history of intravenous drug abuse, preponderance of adenocarcinoma cell type and advanced clinical stage at diagnosis. Adenocarcinoma is the most common histological subtype, and the majority of patients are diagnosed with locally advanced or metastatic carcinoma. Surgery with curative intent remains the treatment of choice for early-stage disease. There is increasing experience in using radiation and chemotherapy for HIV-infected patients who do not have surgical options. Evidence-based treatments for smoking-cessation with demonstrated efficacy in the general population must be routinely incorporated into the care of HIV-positive smokers.

CONCLUSIONS: Pulmonary involvement in HIV includes Kaposi's sarcoma, Non-Hodgkin lymphoma, and primary lung cancer. Adenocarcinoma can have very aggressive clinical course and can present in locally advanced stage as oppose to what has been previously described as extensive pleural involvement. Patients with advanced NSCLC have poor prognosis. Prospective clinical trials are needed to define the optimal detection and treatment strategies for lung cancer in HIV infected patients.

1) Carcinoma of the lung in HIV-positive patients: findings on chest radiographs and CT scans. White CS. Haramati LB. Elder KH. Karp J. Belani CP. American Journal of Roentgenology. 164(3):593-7, Mar 1995.

DISCLOSURE: The following authors have nothing to disclose: Ameer Rasheed, Viswanath Vasudevan, Farhad Arjomand

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