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Lung Cancer |

Pseudomesotheliomatous Adenocarcinoma of the Lung in a Young Nonsmoker With Parenchymal Scarring From Tuberculosis

Michael Braganza, MD; Julie Chou, MD; Juri Janovcik, MD; Julie Jarand, MD; Dina Fisher, MD
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University of Calgary, Calgary, AB, Canada


Chest. 2014;145(3_MeetingAbstracts):320A. doi:10.1378/chest.1819624
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Abstract

SESSION TITLE: Cancer Cases

SESSION TYPE: Case Reports

PRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AM

INTRODUCTION: Pseudomesotheliomatous adenocarcinoma(PMA) of the lung is an uncommon variant lung cancer that is clinically and radiographically difficult to distinguish from mesothelioma.[1] Based on previously reported cases, these patients tend to be older male smokers. Similar to mesothelioma, PMA of the lung has a poor overall survival of 6 months in the literature.

CASE PRESENTATION: We describe a case of a 34 year old male non-smoker who was diagnosed with PMA of the lung after presenting with left sided chest pain and significant weight loss. CT scan demonstrated diffuse left sided pleural thickening emanating from the left upper lobe and metastatic disease to several ribs. Biopsy and immunohistochemical staining revealed a moderately differentiated adenocarcinoma. Mesothelioma was ruled out. No exposure was known to increase his risk for pulmonary malignancy. The only significant past medical history was his latent tuberculosis (TB) and previously documented left apical scarring.

DISCUSSION: This report aims to explore the relationship between parenchymal lung scarring from tuberculosis and the inception of PMA of the lung. From literature review, the concept of a “scar” carcinoma is not novel. Since it was first identified in the 1971, multiple theories have been proposed to explain the pathogenesis from scar tissue to scar carcinoma.[2] The incidence of scar carcinoma after TB is known to be higher than other causes. Despite that, there has never been a case report linking TB scarring to pseudomesothelioma of the lung in the English literature.

CONCLUSIONS: In summary, we report a young male whose only risk factor for pulmonary malignancy was TB related parenchymal scarring. His unique presentation with PMA of the lung further reminded us about the protean manifestation of lung cancer. Continued reporting of this uncommon variant of lung cancer is necessary to further characterise the risk factors, prognosis and the most optimal management strategy.

Reference #1: Harwood TR, Gracey DR, Yokoo H. Pseudomesotheliomatous carcinoma of the lung. A variant of peripheral lung cancer. American journal of clinical pathology. Feb 1976;65(2):159-167.

Reference #2: Limas C, Japazer H, Gracia-Bunel R. “Scar” carcinoa of the lung. Chest 1971; 59:219-222.

DISCLOSURE: The following authors have nothing to disclose: Michael Braganza, Julie Chou, Juri Janovcik, Julie Jarand, Dina Fisher

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