SESSION TYPE: Cancer Student/Resident Cases
PRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PM
INTRODUCTION: Pleural effusion is a common presenting manifestation of peripheral adenocarcinoma of lung. Very rarely metastatic pleural tumors spread diffusely within the pleura to form an encasing mass and may be confused with diffuse malignant mesothelioma. We describe a patient who presented with progressive chest pain , dyspnea and weight loss. Thoracic CAT scan revealed unilateral diffuse nodular pleural thickening encasing the lung and producing lung entrapment.
CASE PRESENTATION: A 57 year old male, previously healthy presented with progressive dyspnea, right sided pleuritic chest pain, anorexia and weight loss of 30 lbs over a period of 3 months. He denied cough, hemoptysis, anorexia, night sweats, fever, chills. He admitted to 26 pack years smoking history. He was a construction worker and involved in demolition of buildings in NY city since 1980. On physical examination he was in no acute distress, and vital signs were stable. Chest examination disclosed decreased breath sounds and dullness to percussion on lower right lung zone. Routine blood work up was normal. Chest XR and CT Chest images are attached. Thoracoscopic pleural biopsy and immunochemistry were positive for pleural metastasis with primary adenocarcinoma of lung.
DISCUSSION: Adenocarcinoma of lung is the most common cell type of non-small cell lung carcinoma. Pseudomesotheliomatous adenocarcinoma is an uncommon variant of peripheral lung cancer first described by Harwood et al in 1976. The majority of these patients were men in fifth and sixth decade of life and were heavy smokers. The presenting symptoms include chest pain, cough and dyspnea. Radiographic presentation of diffuse nodular pleural thickening with spread along the fissure and bronchovascular bundles mimicks diffuse malignant mesothelioma. Like Malignant mesothelioma, PMA is an aggressive rapidly growing tumor. Pleural spread of carcinoma lung usually presents as a pleural effusion but it may spread along the pleura in a fashion grossly similar to that of a mesothelioma.
CONCLUSIONS: In conclusion, this case was an unusual presentation of adenocarcinoma of lung. The diagnostic difficulties were caused by his rather non-specific presentation and by the pleural thickning on the CT scan. In a patient with known asbestos exposure,the diffuse nodular pleural thickening, spread along the fissure with lung entrapment mimicked diffuse malignant epithelial mesothelioma.
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DISCLOSURE: The following authors have nothing to disclose: Qammar Abbas, Mukesh Kumar, Viswanath Vasudevan, Saleem Shahzad, Muhammad Ahmad, Praveen Jinnur, Tarkeshwar Tiwary
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