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Diffuse Reticular Nodular Cavity Shadows: A Rare Manifestation of Bronchioalveolar Carcinoma (BAC) FREE TO VIEW

Sindy Cedeño de Jesus, MD; Beatriz Jimenez Rodriguez, MD; Rosa Lina De los Santos de Lopez, MD; Ana Dolores Romero Ortiz, PhD
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Virgen de las Nieves University Hospital, Granada, Spain

Chest. 2014;145(3_MeetingAbstracts):297A. doi:10.1378/chest.1824343
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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: The WHO considers BAC as a subtype of adenocarcinoma (1).accounts for 6.5% of pulmonary neoplasias. Its incidence in Spain it is 3%, and in the US it is 3-24%, according to the series(2). Because of its clinical, radiological and histological presentation are variable, we report the case with a subacute clinical presentation and a diffuse cavitated reticulonodular pattern.

CASE PRESENTATION: A 71-year-old patient, occasional cigar smoking. Retired, with an active life. Two weeks before he had complained of moderate dyspnea, dry cough, and low-grade fever. A chest X-ray was performed and he was diagnosed of probable atypical pneumonia and was prescribed empirical antibiotic. Two weeks later he came to the hospital, now with minimal effort dyspnea and asthenia. He had lost eight kilograms over the past two weeks. He has not had fever again The physical examination revealed tachypnea at rest with 96% oxygen saturation while breathing ambient air. Afebrile. Blood pressure 135/75mmHg, heart rate: 65 bpm. The pulmonary auscultation evidenced bilateral crackles. A new radiography was performed (Image 1). The laboratory tests performed, including blood count, blood biochemistry, microbiological cultures and serology for atypical pneumonia, were negative. The CT scan showed a large number cavitated nodules (Image 2). Bronchoalveolar lavage was performed and the microbiological, cytological samples and biopsies taken, were negative. Because of the fast progression, it was decided to performed a biopsy by videothoracoscopy. The diagnosis obtained by pathology was mucinous bronchioloalveolar carcinoma with focal areas of adenocarcinoma with EGFR +.

DISCUSSION: BAC is characterized, according to the WHO, by development distal to the terminal bronchiolus up to the acinar epithelium, involving aprogressive lepidic growth, respecting the underlying pulmonary architecture, with susceptibility to aerogenous, vascular or lymphatic dissemination. It may include multicentric lesions separated from the primary tumor(1). It can occur characteristically as a solitary pulmonary nodule, segmental or lobar consolidation and diffuse pulmonary nodules, although most of the patients show a mixed component (3) as our case.

CONCLUSIONS: The variable radiological presentation of BAC makes the diagnosis challenging, and sometimes delays the final diagnosis. Therefore, BAC must be considered in patients with cavitated reticulonodular infiltrates

Reference #1: International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma .Thorac Oncol. 2011 Feb;6(2):244-85

Reference #2: The epidemiology of bronchoalveolar carcinoma over past two decades, analysis of the SEER database Lung cancer 2004; 45:137- 42

Reference #3: The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2:706

DISCLOSURE: The following authors have nothing to disclose: Sindy Cedeño de Jesus, Beatriz Jimenez Rodriguez, Rosa Lina De los Santos de Lopez, Ana Dolores Romero Ortiz

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