Lung Pathology: Fellow Case Report Slide: Lung Pathology |

Lambertosis: A Lung Cancer Mimic FREE TO VIEW

Garrett Harp, MD; Gilbert Seda, MD; Gregory Matwiyoff, MD; John Payton, DO
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Naval Medical Center San Diego, San Diego, CA

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

Chest. 2016;150(4_S):786A. doi:10.1016/j.chest.2016.08.882
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SESSION TITLE: Fellow Case Report Slide: Lung Pathology

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Monday, October 24, 2016 at 03:15 PM - 04:15 PM

INTRODUCTION: Lung cancer is the leading cause of cancer death worldwide. The United States Preventive Services Task Force (USPSTF) recommends screening people at high risk for lung cancer based on age and smoking history with low-dose computed tomography (CT). We present a case of a patient with a pulmonary nodule associated with bronchiolar metaplasia identified on lung cancer screening.

CASE PRESENTATION: A 66-year-old Caucasian man with moderate chronic obstructive pulmonary disease (COPD) presented to pulmonary medicine clinic after a 1.8-cm solitary pulmonary nodule was found in his right upper lobe (RUL) via a lung cancer screening CT. He smoked 1.5 packs per day for 35 years and quit 3 years ago. A positron emission tomography (PET) scan showed the RUL nodule to be moderately hypermetabolic with an SUV of 4.1 with no hypermetabolic lymph nodes. The patient was referred to interventional radiology for a transthoracic needle biopsy that was non-diagnostic. The patient underwent surgical wedge resection of the RUL nodule. Pathology noted that the tissue showed smoking-related diffuse parenchymal lung disease with localized fibrosis and peribronchiolar metaplasia.

DISCUSSION: Bronchiolar metaplasia is a reactive condition where bronchiolar epithelium extends beyond respiratory bronchioles along the alveolar septa and replaces normal alveolar lining cells. The process is known as “lambertosis” since it is thought that the metaplastic epithelium is derived from canals of Lambert which normally connect non-respiratory bronchioles to adjacent alveoli. The histopathology of bronchiolar metaplasia is an extension of columnar or ciliated epithelium beyond the alveolar ducts to the alveolar walls. When the metaplasia is extensive, it may appear as nodules measuring 2-5 mm in diameter. Lambertosis is associated with tobacco use and may be a reactive process due to chronic injury to terminal and respiratory bronchioles. The metaplasia is presumed postinflammatory in origin and may be a consequence of bronchiolitis, chronic hypersensitivity pneumonitis, bronchiectasis, or COPD.

CONCLUSIONS: This is the first reported case in the literature of a pulmonary nodule due to bronchiolar metaplasia. We anticipate that, as lung cancer screening increases, we will identify more cases of this postinflammatory nodule.

Reference #1: Allen, T.C. (2010). Pathology of small airways disease. Arch Pathol Lab Med, 134(5), 702-718.

Reference #2: Wick, M.R., et al. (2013). Neoplastic mimics in thoracic and cardiovascular pathology. New York, NY: Demos Medical, 55-63.

DISCLOSURE: The following authors have nothing to disclose: Garrett Harp, Gilbert Seda, Gregory Matwiyoff, John Payton

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