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Lung Cancer |

Primary Lung Cancer With Bilateral Multiple Cavitary Lesions

Ebru Unsal, MD; Filiz Cimen, MD; Fatma Canbay, MD; Mujgan Guler, MD
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Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey


Chest. 2014;146(4_MeetingAbstracts):634A. doi:10.1378/chest.1989964
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Abstract

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: Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small-cell lung cancers are the most frequent type of lung tumors, with two major histological subtypes: adenocarcinomas and squamous cell carcinomas (1). Squamous-cell carcinoma is the most common histological type of lung cancer to cavitate. Multiple cavitary lesions in primary lung cancer are rare, however, multifocal bronchoalveolar cell carcinoma can occasionally have multiple cavitary lesions (2). We presented a primary lung cancer case for its rare radiological finding.

CASE PRESENTATION: Sixty six years old male patient. He was a farmer. He had operation for inguinal hernia 40 years ago and had cataract surgery two years ago. He had smoking history as 100 package years. Also his brother died from lung cancer. When he admitted to hospital, he had dispnea and hemoptysis for 2,5 months. On physical examination, there was swelling of the veins in the upper extremity and neck. Respiratory sounds were decreased. Oxygen saturation was 90%. Respiratory rate was 14/minute. On routine tests, hemoglobine: 15.6, WBC: 6800 Ne:4100, hct 47.4% PLT: 303000 INR: 1.11 Sedimantation:34/hr. The chest radiography showed enlargement of mediastinum and bilateral nodular density of cavitation. Thoracic CT was performed and mass in the right paratracheal area including both mediastinal and hilar lymphadenopathy and left upper lobe the lesion contoured approximately 5 cm in diameter, 4cm sized cavities in both lungs and multiple metastatic nodules were demonstrated. The patient was referred to the radiation oncology in terms of SVCS. Without a tissue diagnosis, the patient had 10 days palliative radiotherapy for superior vena cava syndrome (SVCS). Fiberoptic bronchoscopy (FOB) was performed. Apicoposterior segment of the left upper lobe was closed with EBL. Apical segment of right upper lobe was infiltrated with fragile mucosal lesion. FOB biopsies from both systems were reported as squamous-cell pulmonary carcinoma. FOB lavage was reported as negative for ARB. The case was presented to the oncology council and chemotherapy with the diagnosis of stage 4 non small cell lung cancer was reported.

DISCUSSION: Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small-cell lung cancers are the most frequent type of lung tumors, with two major histological subtypes: adenocarcinomas and squamous cell carcinomas (1). Cavitation in primary lung cancer is not rare. Cavitation detected on plain chest radiographs has been reported in 2% to 16 % of primary lung cancers, and it is detected with computed tomography (CT) in 22% of primary lung cancers. Squamous-cell carcinoma is the most common histological type of lung cancer to cavitate (82% of cavitary primary lung cancer), followed by adenocarcinoma and large cell carcinoma. Cavities may be formed as a result of a unidirectional check-valve mechanism. Another mechanism of cavity formation may depend on the ischemic or colliquative tumor necrosis associated with neutrophil infiltration into the central portion of lesion. Cavitary formation due to tumor necrosis is common in squamous cell carcinomas, particularly in those developing peripherally in the lung. Multiple cavitary lesions in primary lung cancer are rare, however, multifocal bronchoalveolar cell carcinoma can occasionally have multiple cavitary lesions (2,3).

CONCLUSIONS: Primary lung cancer especially squamous-cell carcinoma stage IV also should be evaluated for the differential diagnosis of multiple cavitary lesions.

Reference #1: 1. Alberg AJ, Brock MV, Samet JM. Epidemiology of lung cancer: looking to the future. J Clin Oncol. 2005;23:3175-3185.

Reference #2: 2. Mouroux J, Padovani B, Elkaïm D, Richelme H. Should cavitated bronchopulmonary cancers be considered a separate entity? Ann Thorac Surg. 1996;61:530-532.

Reference #3: 3. Onn A, Choe DH, Herbst RS, et al. Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome. Radiology.2005;237:342-347.

DISCLOSURE: The following authors have nothing to disclose: Ebru Unsal, Filiz Cimen, Fatma Canbay, Mujgan Guler

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