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Advanced Large Cell Lung Tumor With Neuroendocrine Differentiation in an HIV Positive Patient: A Case Report FREE TO VIEW

Abhay Vakil, MD; Hineshkumar Upadhyay, MD; Khalid Sherani, MD; Kelly Cervellione, PhD; Mohammed Babury, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Chest. 2014;145(3_MeetingAbstracts):309A. doi:10.1378/chest.1826434
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SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Case Report Poster

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

INTRODUCTION: Large cell tumor of the lung with neuroendocrine differentiation is extremely rare, accounting for only 3 % of all lung cancers. Its association with HIV/AIDs is even rarer. Typical presentation includes cough, post obstructive pneumonia, and hemoptysis. We are reporting the case of a 49 year old man with a 15 year history of HIV who was found to have an atypical presentation of a large cell tumor of the lung with neuroendocrine differentiation.

CASE PRESENTATION: A 49-year-old nonsmoker man with HIV/AIDs, currently on HAART therapy presented with progressively worsening right-sided pleuritic chest pain over 1 month. He denied any fever, cough, hemoptysis or weight loss. Physical examination revealed decreased right sided breath sounds and decreased tactile vocal fremitus. Imaging studies showed a massive loculated right sided pleural effusion with underlying atelectasis, multiple pleural masses, but no lung mass. Thoracocentesis revealed hemorrhagic exudative fluid with cytology negative for malignant cells. Video assisted thoracoscopic biopsy of pleural masses and subsequent special histological staining were positive for synaptophysin and CD56, confirming stage IV large cell tumor of lung origin with neuroendocrine differentiation.

DISCUSSION: To the best of our knowledge, this is the only reported case of large cell neuroendocrine tumor in a patient with HIV/AIDs that presented with pleuritic chest pain, loculated effusion, multiple pleural masses and no lung mass. Since this is one of the histologically rarer types of lung cancer, the insidious onset of symptoms and aggressive nature leads to an extremely poor prognosis. The reported 5 year survival rate is 13-47 % overall, and 0 % for stage IV disease. Due to rarity of the disease there are no clinical trials to document any effective treatment. However, surgical resection is recommended for stage I-II disease which may improve outcomes. Adjuvant chemotherapy has been shown to improve outcomes in small studies.

CONCLUSIONS: High clinical vigilance and awareness about this rare and aggressive histologic variant of lung cancer might lead to early diagnosis and possibly improved outcomes with better patient care.

Reference #1: Pavan Kumar Bhamidipati, Amanda Ribbeck, Goldees Liaghati-Nasseri, Ramesh Kumar,Babu Paidipaty B, and John Bartnik, "An Atypical Presentation with Diagnostic Challenge of a Large Cell Neuroendocrine Cancer of Lung: A Case Report and Review of the Literature" Lung Cancer International Volume 2011 (2011), Article ID 912098, 6 pages

Reference #2: L. Sun, S. Sakurai, T. Sano, M. Hironaka, O. Kawashima, and T. Nakajima, “High-grade neuroendocrine carcinoma of the lung: comparative clinicopathological study of large cell neuroendocrine carcinoma and small cell lung carcinoma,” Pathology International, vol. 59, no. 8, pp. 522-529, 2009.

Reference #3: S. Yamazaki, I. Sekine, Y. Matsuno et al., “Clinical responses of large cell neuroendocrine carcinoma of the lung to cisplatin-based chemotherapy,” Lung Cancer, vol. 49, no. 2, pp. 217-223, 2005.

DISCLOSURE: The following authors have nothing to disclose: Abhay Vakil, Hineshkumar Upadhyay, Khalid Sherani, Kelly Cervellione, Mohammed Babury

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