Lung Cancer |

Age No Bar for Lung Carcinoma: Case of Squamous Carcinoma in Nonsmoker Young Man FREE TO VIEW

Amrit Pal Kansal, MD; Gopal Chawla, MD; Naresh Kumar, MD; Komaldeep Kaur, MD
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Government Medical College, Patiala, Punjab, India

Chest. 2014;146(4_MeetingAbstracts):633A. doi:10.1378/chest.1988566
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SESSION TITLE: Cancer Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Common age group of lung cancer is 40-80 years, only less than 10% occur below 30 years. Only 2.7% are due to squamous cell carcinoma. Lung cancer in young age with pleural effusion is rather an atypical one and high index of suspicion is required for its diagnosis. Here we report a case of a 26year old male presenting with Pleural effusion that was ultimately diagnosed with Stage IV non small cell carcinoma.

CASE PRESENTATION: A 26 year old immunocompetent male presented with intermittent fever, cough with mild expectoration, chest pain more on right side and breathlessness for two months, already on anti tubercular therapy on radiological basis, not responding even after one month. He was not a smoker and takes alcohol occasionaly but was bettle nut chewer. He had cervical lymph node left side measuring 1 X 1 cm.Chest radiograph revealed right sided pleural effusion with right lower zone heterogeneous infiltration. Pleural tap yielded 100 ml of hemorrhagic pleural fluid. MGG(May-Grünwald-Giemsa) and PAP(Papanicolaou stain) stained cytological smears showed small and large clusters malignant squamous epithelial cells with occasional keratin pearls, suggesting squamous cell carcinoma with primary possibly in lung. CECT showed bronchogenic carcinoma, mass in right lower lobe and mild pleural effusion with mediastinal and cervical lymphadenopathy Thus, the patient was given a diagnosis of pT2bN1M1a stage IV disease .On bronchoscopy multiple nodules were seen in right lower lobe bronchus. Endobronchial lung biopsy was taken which confirmed diagnosis of squamous cell carcinoma.

DISCUSSION: It is unknown why younger carcinoma patients are first seen with advanced disease like in our case in Stage IV. Because bronchogenic carcinoma in this age group is rare, both public and professional awareness is limited. Young patients may not suspect serious illness. Moreover, physicians often may not suspect an underlying carcinoma despite persistent pulmonary symptoms or abnormal findings on chest roentgenograms. The mean duration of symptoms before diagnosis is usually 4 -5 months. The patients who have persistent signs of pulmonary disease and a history of heavy smoking, regardless of age or sex, must be considered at risk for lung cancer. Diagnostic tests should be performed early to exclude the possibility of lung cancer. If non-small cell bronchogenic carcinoma is diagnosed and signs of distant metastasis are lacking, exploration should be done because improved survival depends on surgical resection.

CONCLUSIONS: While considering the diagnosis of a case of pleural effusion, in context of India, many prefer to consider tuberculosis as the first differential, while diagnosis of malignancy as the least likely.This case is rare because of the patient’s age, histology and background. The risk factor for lung cancer is unclear. Because the rarity of the disease often delays the correct diagnosis of cancer, it is very important for all clinicians to consider the possibility of lung cancer in young patients. The consideration and aggressive treatment may lead to an earlier diagnoses and a better prognosis.

Reference #1: Ramalingam S, Pawlish K, Gadgeel S, et al. Lung cancer in young patients: analysis of a surveillance, epidemiology, and end results database. J Clin Oncol 1998; 16: 651-7.

Reference #2: Jubelirer SJ, Wilson RA. Lung cancer in patients younger than 40 years of age. Cancer 1991; 67: 1436-8.

Reference #3: Zhang J, Chen SF, Zhen Y, et al. Multicenter analysis of lung cancer patients younger than 45 years in Shanghai. Cancer 2010; 116: 3656-62.

DISCLOSURE: The following authors have nothing to disclose: Amrit Pal Kansal, Gopal Chawla, Naresh Kumar, Komaldeep Kaur

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