Lung Cancer |

A Rare Case of Pulmonary Alveolar Proteinosis Coexisting With Lung Cancer FREE TO VIEW

Laurie Rice, MD; Trina Hollatz, MD
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University of Wisconsin Hospital and Clinics, Madison, WI

Chest. 2015;148(4_MeetingAbstracts):538A. doi:10.1378/chest.2232456
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SESSION TITLE: Lung Cancer Cases

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 25, 2015 at 10:45 AM - 12:00 PM

INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by accumulation of periodic acid-Schiff (PAS) positive lipoproteinaceous material in the alveolar space. Often it is idiopathic, autoimmune, or associated with hematologic malignancies. Here we present a rare case of PAP occurring in association with lung cancer.

CASE PRESENTATION: A 60 year old male with a history of stage IB squamous cell lung cancer status post video assisted thorascopic surgery (VATS) right lower lobe (RLLL) lobectomy presented with worsening cough and dyspnea with exertion. A CT chest was obtained which showed bilateral ground glass opacities in a “crazy paving” pattern and an enlarged subcarinal lymph node. Bronchoscopy with transbronchial biopsies was performed, and pathology was consistent with pulmonary alveolar proteinosis (PAP) and the subcarinal node was positive for squamous cell carcinoma. Pt underwent whole lung lavage with significant improvement of symptoms. Repeat CT chest also showed significant improvement in ground glass opacities. Patient opted against treatment for his malignancy and is alive 18 months later without recurrence of the PAP.

DISCUSSION: This case demonstrates that PAP can occur in association with lung cancer. In retrospect there was an area of ground glass opacities prior to his VATS that likely represented PAP coexisting with the lung cancer. To the best of our knowledge, this is the sixth case report of PAP that occurred prior to, or coexisting with lung cancer. Lui et al reported a case of PAP associated with squamous cell carcinoma, and postulated this may be due to secretion of chemical immune inhibitors. In that case, PAP spontaneously resolved within six month of cancer resection. However, in our case, the patient’s PAP improved without cancer treatment, speaking against a mechanism of chemical immune inhibitor secretion.

CONCLUSIONS: PAP can coexist with lung cancer, and PAP should be considered in the differential for diffuse ground glass opacities in patients with a history of, or newly diagnosed lung cancer.

Reference #1: Su, KC, et al. 2007. Lung cancer may develop subsequently or coincidently with pulmonary alveolar proteinosis. Lung Cancer. 2007 Oct;58(1):144-8

Reference #2: Kyung-Hwan, K et al. Use of extracorporeal membrane oxygenation during whole lung lavage in pulmonary alveolar proteinosis associated with lung cancer Eur J Cardiothorac Surg (2004) 26 (5): 1050-1051

Reference #3: Liu, H. et al. Lung squamous cell carcinoma in pulmonary alveolar proteinosis. Ann Thorac Cardiovasc Surg 2014; Supp:650-653

DISCLOSURE: The following authors have nothing to disclose: Laurie Rice, Trina Hollatz

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