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Chest Infections: Noninfectious "Pneumonia" |

Slow-Resolving Pneumonia Secondary to Mucinous Adenocarcinoma FREE TO VIEW

Yaoqian Cao, MHA; Jie Cao, MHA
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Tianjin Medical University General Hospital, Tianjin, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A133. doi:10.1016/j.chest.2016.02.138
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SESSION TITLE: Noninfectious “Pneumonia”

SESSION TYPE: Case Report Slide

PRESENTED ON: Sunday, April 17, 2016 at 01:00 PM - 02:00 PM

INTRODUCTION: Pneumonic-type carcinoma of lung (PTCL) is pathological and radiographic entity, which is defined as diffuse non-obstructive parenchymal infiltration[1]. It brings the difficulty to certain diagnosis because of no specificity.

CASE PRESENTATION: A 64 -year-old man presested with a nonproductive cough without fever and dyspnea. Chest scan showed the bilateral consolidation with air bronchogram in the lower lobes, predominantly in the right lung (Figure 1). He was initial diagnosed with “pneumonia” on admission, and received antibiotic therapy with improvement. The recurrence of cough occured in the next year. Chest radiography showed unabsorbed consolidation (Figure2) compared with before. He was admitted to our hospital and complainted of a lot of frothy sputum, dyspnea, and fever after 2 year. A chest scan demonstrated diffuse pulmonary parenchymal involvement with bilateral ground-glass opacity and consolidation (Figure 3). A bronchoscopic exam revealed a lot of white frothy secretions with congestive, edema mucosa in each bronchus (Figure 4), and was taken the TBLB. ROSE merely discovered the cellcular degeneration and necrosis (Figure 5). A bronchial pathology showed the adenocarcinoma in the left superior lobe (Figure 6).

DISCUSSION: In our case, symptoms are nonspecific. There is range from local consolidation to diffuse pulmonary parenchymal involvement on chest scan for two years. PTCL is not easy to distinguish from infectious pneumonia on the basis of chest imaging. The most common pathological subtype of diagnosed PTCL is adenocarcinoma. A new classification of lung adenocarcinoma was proposed by international multidisciplinary experts from IASLC/ATS/ERS[2]. The definition of mucinous BAC was replaced by IMA due to its distinct radiologic, morphologic and genetic fetures. IMA, which contained components of columnar or goblet cells with abundant intracellular or extracellular mucus, was seen as a a subtype of lung adenocarcinoma[3]. IMA was supposed to be more malignant than other subtype of lung adenocarcinoma. The clinical outcome of IMA depends on different morphological performances.

CONCLUSIONS: Lung carcinoma is an important diagnosis in the work-up of slow-resolving pneumonia. A biopsy are carried out as soon as possible if patients are considered as slow-resolving pneumonia.

Reference #1: Jung JI, Kim H, Park SH, et al. CT differentiation of pneumonic-type bronchioloalveolar cell carcinomia and infection pneumonia. Br J Radiol.2001;74:490-494.

Reference #2: Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011;6:244-85.

Reference #3: Cadranel J, Quoix E, Baudrin L, et al; IFCT-0401 Trial Group. IFCT-0401 Trial: a phase II study of gefitinib administered as first-line ­treatment in advanced adenocarcinoma with bronchioloalveolar carcinoma subtype. J Thorac Oncol. 2009;4(9):1126-1135.

DISCLOSURE: The following authors have nothing to disclose: Yaoqian Cao, Jie Cao

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