Lung Cancer |

Bronchioloalveolar Carcinoma: A Diagnostic Challenge FREE TO VIEW

Julián Ceballos Gutiérrez, DM; Juan Cruz Rueda, DM; Cintia Merinas López, DM; Ana Dolores Romero Ortiz, DM
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Hospital Universitario Virgen de las Nieves, Granada, Spain

Chest. 2014;145(3_MeetingAbstracts):290A. doi:10.1378/chest.1824024
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SESSION TITLE: Cancer Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Bronchioloalveolar carcinoma is a subtype of adenocarcinoma characterized by peripheral location, good histological differentiation, lepidic growth pattern and potential for aerogenous and lymphatic dissemination. We report the case of a patient with a diffuse variant of bronchioloalveolar carcinoma (BAC) which is confused with interstitial conditions such as hypersensitivity pneumonitis, atypical pneumonia, idiopathic interstitial pneumonitis or respiratory bronchiolitis.

CASE PRESENTATION: A 69-year old male patient, a heavy smoker in a good overall condition, without constitutional symptoms, who had several months of dyspnea progressing with moderate exertion and fine crackles heard in the right hemithorax with a 85% oxygen saturation. Respiratory function tests with a 68.8% diffusion and the X-ray showed infiltration predominately in upper fields. Autoimmunity tests with negative results, and a chest CT scan was made showed a groundglass pattern with multiple centrilobular nodules affecting almost the entire pulmonary parenchyma of the right lung and upper left lobe, with septal thickening in basal segments. A BAL was performed which was negative for microorganisms. A PET/TAC showed a moderate diffuse bilateral metabolic activity, predominantly in the right lung. In view of the lack of a diagnosis, a pulmonary biopsy was performed by videothoracoscopy with results consistent with non-mucinous bronchioloalveolar carcinoma with a focal areas of adenocarcinoma.

DISCUSSION: The radiological presentation of bronchioloalveolar carcinoma is highly variable; the most common radiological patterns are single or multiple peripheral nodules, lobar consolidation and diffuse infiltrates that are similar in appearance to bacterial pneumonia. In our case, the patient presented images showing diffuse bilateral infiltrates in a groundglass pattern with multiple centrilobular nodules and cottony agglomerates. A pulmonary biopsy was taken because diffuse interstitial pneumonopathy was suspected. This proves the importance of expanding the differential diagnoses in patients with diffuse pulmonary pathology and include bronchiole alveolar carcinoma as another diagnosis.

CONCLUSIONS: The variable characteristics of bronchioloalveolar carcinoma and its diffuse presentation make confusion with a number of diseases probable, including interstitial lung diseases. Therefore we consider it advisable to obtain histopathological confirmation in those patients with atypical presentations or slow progression, and to consider bronchioloalveolar carcinoma as a diagnostic alternative

Reference #1: Howar J West. Bronchioloalveolar carcinoma, including adenocarcinoma in situ. Wolters Kluwer Health. Up to date Review Juny 2013

Reference #2: American thoracic society/european respiratory society international multidiciplinary classification of lung adenocarcinoma. Jthorac Oncol 2011; 6:244

Reference #3: H. Bronchioloalveolar carcinoma masquerading as pneumonia. Respir Care 2004; 49:1349

DISCLOSURE: The following authors have nothing to disclose: Julián Ceballos Gutiérrez, Juan Cruz Rueda, Cintia Merinas López, Ana Dolores Romero Ortiz

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