Lung Cancer |

An Unusual Presentation of Squamous Cell Carcinoma of Lung in an Immunocompromised Patient Mimicking Pulmonary Artery Embolism FREE TO VIEW

Joyce Pang, MD; Girish B Nair, MBBS; Jonathan Ilowite, MD; Jason Hoffman, MD; Shalinee Chawla, MD
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Winthrop University Hospital, Mineola, NY

Chest. 2013;144(4_MeetingAbstracts):616A. doi:10.1378/chest.1702518
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SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Sunday, October 27, 2013 at 07:30 AM - 08:30 AM

INTRODUCTION: Primary lung cancer in the pulmonary vasculature is very uncommon, mostly as pulmonary angiosarcoma. Squamous cell carcinoma causing angioinvasion is extremely rare. Here, we observe the third case to have ever been reported of squamous cell carcinoma in the pulmonary artery.

CASE PRESENTATION: A 59 year old male who presented with worsening pleuritic chest pain and shortness of breath of 3 weeks duration. He also had 30 lbs weight loss, decreased oral intake over the past 6 month. His past medical history was significant for chronic myelogenous leukemia for which was being treated with Imatinib. He is an active smoker with a 30-pack-year smoking history. His vitals on admission were stable, BMI was 35 kg/m2. Examination was otherwise unrevealing. Laboratory data revealed a elevated d-dimer level of 1856 and a computed tomography pulmonary angiography was performed which demonstrated a complete occlusion of the left pulmonary artery with multiple areas of consolidation, air-fluid levels in the left upper lobe, lingula and lower lobe. Lower extremity dopplers, echocardiogram and AFB testing were negative. Day 2 of hospitalization, patient underwent an endobronchial ultrasonograph guided fine needle aspiration of the pulmonary artery mass. However, cytology was negative. Day 12, patient underwent percutaenous endovascular biopsy of pulmonary artery mass via right heart catherization revealing diagnosis of squamous cell carcinoma. Brain MRI and a bone scan was negative for any metastasis. Subsequently, he underwent a left pnemonectomy and discharged on day 35 for outpatient chemotherapy.

DISCUSSION: Discussion: Intrapulmonary spread of primary lung cancer is exceedingly rare. Only 5 prior cases have been reported in literature and 2 of which are squamous cell carcinoma in origin. Regardless of type, presentation and findings on CT often mimics pulmonary thromboembolism. Therefore, biopsy via endobronchial ultrasound or surgical intervention is often required for proper diagnosis. Given the rarity of angioinvasive carcinoma, there is little data regarding its treatment, response rates, or prognostic factors. This warrants further investigation when such diagnosis is made.

CONCLUSIONS: When approaching patients with complete obscuration of the pulmonary artery, a high index of suspicion is required in distinguishing patients with pulmonary thromboembolism and angioinvasive disease.

Reference #1: Okamoto, Y, Tscuhiya K, Nakajima, M, Yano K, and Kobayashi T. Primary Lung Cance with Growth into the Lumen of the Pulmonary Artery. Ann Thoracic Cardiovasc Surg. 2009; 15: 186-188.

Reference #2: Goto T, Maeshima A, and Kato R. Lung Adenocarcinoma with Peculiar Growth to the Pulmonary Artery and Thrombus Formation: report of a case. World Journal of Surgical Oncology. 2012; 10: 16.

Reference #3: Estrera AL, Cagle PT, Azizzadeh A, and Reardon MJ. Large Cell Neuroendocrine Carcinoma: An Unusual Presentation. Ann Thorac Surg. 2002; 73: 1957-60.

DISCLOSURE: The following authors have nothing to disclose: Joyce Pang, Girish B Nair, Jonathan Ilowite, Jason Hoffman, Shalinee Chawla

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