Lung Cancer |

Thin Wall Cavity in a Patient With Prior History of Esophageal Adenocarcinoma FREE TO VIEW

Oleksandr Pistun, MD; Malik Deen, MD; Teodoro Santiago, MD
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Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ

Chest. 2014;146(4_MeetingAbstracts):619A. doi:10.1378/chest.1993971
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SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

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

INTRODUCTION: Lung adenocarcinomas represent up to 38% of lung cancer (1). Cavitation of lung cancer has been reported in up to 16 and 4% of primary and metastatic lung cancer respectively (2). Incidence of primary lung tumors arising in cavities caused by other processes is unknown, but has been reported (3). Here we present a case of primary lung adenocarcinoma arising from a cavity wall caused by Mycobacterium Avium Complex in a patient with prior history of esophageal adenocarcinoma.

CASE PRESENTATION: A 68 year old male smoker with history of esophageal adenocarcinoma, successfully treated with chemotherapy and resection of the esophagus two years prior to presentation, was found to have a 2 cm thin cavitary lesion during surveillance imaging. CT-guided needle biopsy of the lesion revealed granulomas. Quantiferon Gold test was negative. He was followed clinically, and a repeat CT scan of the chest revealed increasing cavity thickness. Video-assisted wedge lung biopsy revealed poorly differentiated primary lung adenocarcinoma arising in a wall of the cavity and necrotizing granulomata with scant acid-fast bacilli. Tissue culture was positive for Mycobacterium avium complex. The patient did not have recurrence of his disease after the surgery.

DISCUSSION: In a patient with a primary adenocarcinoma of esophagus, a new lung lesion always suspicious for metastatic disease. However, smoking history is an important risk factor for pulmonary neoplasms. Although cavitary lung lesions can represent cavitating tumor, it is more prevalent in infectious processes. Change in the thickness of the cavitary lesion should raise a suspicion about alternative diagnosis or concomitant process, such as malignancy.

CONCLUSIONS: Lung cancer should be suspected in cases with thick wall cavities and when cavity thickness increases.

Reference #1: Spiro SG at al. Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes. Chest. Sep 2007;132(3 Suppl):149S-160S.

Reference #2: Cavities in the Lung in Oncology Patients: Imaging Overview and Differential Diagnoses Ritu R. Gill, and al. Disclosures Appl Radiol. 2010;39(6):10-21.

Reference #3: Nihon Kokyuki Gakkai Zasshi. 2003 Mar;41(3):177-80.

DISCLOSURE: The following authors have nothing to disclose: Oleksandr Pistun, Malik Deen, Teodoro Santiago

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