Lung Cancer: Lung Cancer |

Bronchoalveolar Carcinoma (BAC) Masquerading as Cryptogenic Organising Pneumonia: A Unique Presentation FREE TO VIEW

Ram Chopra, MD; R.K. Chopra, MBBS; Vaibhav Pandharkar, MD
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Ruby Hall Clinic, Pune, India

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

Chest. 2016;149(4_S):A264. doi:10.1016/j.chest.2016.02.276
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Bronchoalveolar carcinoma (BAC) is a rare subtype of adenocarcinoma with variable clinical, radiological and histological presentations, often multicentric, and occurs usually in non smokers and asians in age group of 40-70 years. Growth is usually progressive and diffuse. Chest imaging and symptoms may mimic infective pneumonias or ILD / organising pneumonias. BAC accounts for 6.5% of all lung cancers. Physician should suspect BAC if what otherwise appears to be infective pneumonia lacks fever or leukocytosis and does not respond to antibiotics or in case it appears to be organising pneumonia does not respond to steroids. We present a patient who presented with diffuse variant of BAC mistaken for cryptogenic organising pneumonia (COP).

CASE PRESENTATION: 68 years old non smoker male patient presented with two years h/o cough, mucoid expectoration, progressive dyspnoea, profound weight loss and no fever. X-ray chest (fig 1) and CT thorax (fig 2) showed areas of patchy consolidation peripheraly in both lower lobes. Blood chemistry was normal. Sputum showed no organisms. Patient admitted to have been treated with multiple antibiotics by his primary phyiscian but without improvement in symptoms. Initially we entertained a differential diagnosis of chronic eosinophillic pneumonia and COP based on clinico radiological picture and put on steroids. There was no relief & repeat imaging later showed further progression and sputum became copious & watery (bronchorrea). Malignant process was suspected at this stage in view of disease progression and non resolving consolidation. Bronchoalveolar lavage (BAL) fluid showed no eosinophilia, organisms or malignant cells. CT guided lung biopsy was done at this stage & histology interestingly turned out to be adenocarcinoma-bronchoalveolar type (fig 3) with lepedic growth along alveolar walls (mucinous variety).

DISCUSSION: BAC is often known as the masquerader due to unique radiological features (1). BAC may sometimes manifest as COP on chest imaging with diffuse patchy consolidation. Its presentation may often be confused with pneumonia or other inflammatory conditions in the lung and diagnosis of adenocarcinoma (BAC) is entertained only after patient fails to improve with steroids or antibiotics. In our patient the progression of disease process with clinical and radiological deterioration led us to suspect underlying malignant process. Patient had failed steroid and antibiotic therapies and ultimately biopsy clinched the diagnosis of BAC.

CONCLUSIONS: BAC presenting as bilateral diffuse pulmonary consolidation may be mistaken for COP, delaying the diagnosis, treatment and exposing the patient to toxicity of unnecessary treatment. BAC should be one of the differential diagnosis of diffuse lung disease and biopsy confirmation be considered in unusual presentations.

Reference #1: V Pathaketal. Pulmonary adenocarcinoma masquerading as diffuse inflammatory interstial lung disease, Respiratory medicine CME, 2011, vol.4(2) 67-69

DISCLOSURE: The following authors have nothing to disclose: Ram Chopra, RK Chopra, Vaibhav Pandharkar

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