SESSION TITLE: Cancer Student/Resident Case Report Posters II
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Radiation-induced lung cancer was first described in association to radon from uranium mines. More recently, computed tomography of chest has been associated with risk for cancer using data from atomic bomb survivors. We describe an alternative source of radiation, laser, as a suspected contributor to our patient’s microscopic adenocarcinoma of the lung.
CASE PRESENTATION: A 27 year old female, active smoker was incidentally found to have a solitary pulmonary nodule on a CAT scan, which was performed for the evaluation of nephrolithiasis. She had an occasional chronic cough, which she attributed to nasal congestion. She had a normal physical examination. Her CAT scans of the chest revealed an 8 mm right lower lobe pulmonary nodule and nonspecific right middle lobes infiltrate (Figure 1). Three months later on PET/CT, the patient was found to have no abnormal activity in the right lower lobe nodule and right middle lobe infiltrate, but intense uptake in her right breast (Figure 2). Her mammography was inconclusive. She underwent a breast biopsy, and it was determined that the culprit lesion was not in the breast. Anatomically, the radiographic images aligned with a tattoo over the breast, for which she had received laser treatments for tattoo removal the previous year. The tattoo also aligned with the right middle lobe pulmonary infiltrate seen on CAT scan of the chest. She underwent video-assisted thorascopic wedge biopsy of her pulmonary nodule and infiltrate. Right middle lobe infiltrate was found to contain 1 mm of adenocarcinoma. Via multidisciplinary tumor conference, she was felt to have had an acceptable surgical resection. It was decided not to have a completion lobectomy or chemotherapy, but to continue observation. Upon repeat PET scan one year post-procedure, she was found to have complete resolution of her PET positive breast lesion without further intervention.
DISCUSSION: Laser tattoo removal is based on the principle of selective thermolysis. The laser light of a particular wavelength is absorbed by tattoo pigments in the skin, which then become disrupted and absorbed. While the depth of penetration of the laser itself may be minimal, the thermal and immunologic effects may involve deeper tissues.
CONCLUSIONS: Laser induced scar tissue from tattoo removal in the lung with subsequent development of microscopic lung cancer is a novel form of radiation induced lung cancer which, to our best knowledge, has not yet been described. With the increasing use of cosmetic lasers, greater caution and more information are required.
Reference #1: Mould RF. Depleted uranium and radiation-induced lung cancer and leukaemia. British Journal of Radiology 2004:74:677-683
Reference #2: Brenner M, Shankel T, Wang NS et al. CO2 and Nd:YAG laser-induced pulmonary parenchymal lung injury in a rabbit model. Am J Respir Crit Care Med 1996;153(3):1136-1140
DISCLOSURE: The following authors have nothing to disclose: Min Jung Kim, Fariborz Ashtyani, Deborah Goss
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