RESUMEN
Lung cancer is one of the most lethal solid organ malignancies. Metastasis commonly spreads to the liver, adrenal glands and bone. We report a case of a male patient who presented with an 8 week history of cramping abdominal pain and vomiting. Subsequent investigation revealed evidence of an obstructing small bowel lesion. He underwent a small bowel resection. Histopathology revealed evidence of lung adenocarcinoma as the likely primary disease. Although metastasis of lung adenocarcinoma to the small bowel is rare, early recognition may prevent potentially life-threatening sequelae including bowel perforation and peritonitis.
Asunto(s)
Adenocarcinoma , Obstrucción Intestinal , Intestino Delgado , Neoplasias Pulmonares , Humanos , Masculino , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/complicaciones , Adenocarcinoma/secundario , Adenocarcinoma/complicaciones , Intestino Delgado/patología , Adenocarcinoma del Pulmón/secundario , Adenocarcinoma del Pulmón/complicaciones , Adenocarcinoma del Pulmón/patología , Neoplasias Intestinales/secundario , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/patología , Neoplasias Intestinales/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
This article describes a case of a man in his early 40s who was diagnosed with pulmonary pleomorphic carcinoma (PPC). PPCs are rare and aggressive forms of lung cancer. Chemotherapy is of limited efficacy. We present a case that has seemingly recurred shortly after adjuvant chemotherapy and immunotherapy following an R0 resection for localised disease. Biopsy however was negative for recurrence. PPCs may bear actionable mutations and tyrosine kinase inhibitors may be used when appropriate. Immunotherapy with or without chemotherapy is emerging as the mainstay for metastatic disease despite a lack of evidence from randomised clinical trials.
Asunto(s)
Neoplasias Pulmonares , Humanos , Masculino , Neoplasias Pulmonares/patología , Adulto , Recurrencia Local de Neoplasia , Quimioterapia Adyuvante , Carcinoma/patología , Carcinoma/terapia , Inmunoterapia/métodosRESUMEN
A male patient in his 40s who had been unwell for months with fever of unknown origin and clinicopathological features suspicious for haemophagocytic lymphohistiocytosis presented to hospital with worsening subacute shortness of breath. CT pulmonary angiogram demonstrated ground glass changes involving all lung lobes with an apicobasal gradient. These changes, combined with long-term steroid exposure for granulomatous hepatitis without pneumocystis prophylaxis, raised concern for pneumocystis jirovecii pneumonia (PJP). A subsequent bronchoscopic lavage specimen was positive on PCR for PJP and the patient was started on appropriate therapy. Clinical and radiological changes initially improved but after completion of therapy, symptoms and radiological abnormalities returned. Retreatment with second-line treatment resulted again in initial improvement followed by relapse with acute deterioration. Further investigations for an alternate diagnosis were made, with a surgical lung biopsy performed finally revealing immunosuppression-related Epstein-Barr virus positive large B cell lymphoma with lymphomatoid granulomatosis of grade 3 pattern.
Asunto(s)
Granulomatosis Linfomatoide , Neumonía por Pneumocystis , Humanos , Granulomatosis Linfomatoide/diagnóstico , Granulomatosis Linfomatoide/tratamiento farmacológico , Masculino , Diagnóstico Diferencial , Adulto , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/tratamiento farmacológico , Pneumocystis carinii/aislamiento & purificación , Tomografía Computarizada por Rayos X , Pulmón/diagnóstico por imagen , Pulmón/patologíaRESUMEN
The combination therapy of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) and mitogen-activated protein kinase kinase (MEK) inhibitors is approved for treating patients with BRAF V600E-positive tumours, including melanoma and lung cancer. Several case reports indicated autoimmune side effects associated with the use of BRAF and MEK inhibitors. Still, the effects of these drugs on the immune system were not fully elucidated. Here, we report a patient with large-vessel vasculitis diagnosed after initiation of treatment with dabrafenib and trametinib for BRAF V600E-positive metastatic lung adenocarcinoma. She was a never-smoker woman in her early 70s who presented with a chronic cough and was diagnosed with BRAF V600E-positive metastatic lung adenocarcinoma by transbronchial lung biopsy. She was successfully treated with prednisolone and methotrexate while BRAF and MEK inhibitors were continued. We should be careful about autoimmune diseases using BRAF and MEK inhibitors.
Asunto(s)
Adenocarcinoma del Pulmón , Imidazoles , Neoplasias Pulmonares , Oximas , Inhibidores de Proteínas Quinasas , Proteínas Proto-Oncogénicas B-raf , Piridonas , Pirimidinonas , Vasculitis , Humanos , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Proteínas Proto-Oncogénicas B-raf/genética , Femenino , Piridonas/efectos adversos , Piridonas/uso terapéutico , Pirimidinonas/uso terapéutico , Pirimidinonas/efectos adversos , Neoplasias Pulmonares/tratamiento farmacológico , Anciano , Adenocarcinoma del Pulmón/tratamiento farmacológico , Imidazoles/efectos adversos , Imidazoles/uso terapéutico , Oximas/efectos adversos , Oximas/uso terapéutico , Vasculitis/inducido químicamente , Inhibidores de Proteínas Quinasas/efectos adversos , Inhibidores de Proteínas Quinasas/uso terapéutico , Prednisolona/uso terapéutico , Metotrexato/uso terapéutico , Metotrexato/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéuticoRESUMEN
A man in his 80s was undergoing immunotherapy with pembrolizumab, an anti-PD-1 monoclonal antibody, following his diagnosis of adenocarcinoma of primary lung origin. 24 weeks into treatment, the patient reported experiencing loose stools associated with malaise and poor appetite but no further symptoms. This progressed in frequency and a clinical diagnosis of grade 2 immune checkpoint inhibitor colitis was made. Management with oral prednisolone was commenced but symptoms persisted. Common enteric infections had been ruled out, as were coeliac disease and hyperthyroidism. Flexible sigmoidoscopy and colonoscopy results were not in keeping with colitis, having revealed normal looking mucosa. Following this, a faecal elastase level was found to be low. A diagnosis of pembrolizumab-induced pancreatic exocrine insufficiency was made, and stool frequency and consistency swiftly improved following the use of pancreatic enzyme replacement therapy.
Asunto(s)
Anticuerpos Monoclonales Humanizados , Diarrea , Inhibidores de Puntos de Control Inmunológico , Humanos , Masculino , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Diarrea/inducido químicamente , Diarrea/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anciano de 80 o más Años , Neoplasias Pulmonares/tratamiento farmacológico , Insuficiencia Pancreática Exocrina/inducido químicamente , Insuficiencia Pancreática Exocrina/tratamiento farmacológico , Colitis/inducido químicamente , Colitis/tratamiento farmacológico , Adenocarcinoma/tratamiento farmacológicoRESUMEN
We report a young pregnant woman with large midline thoracic mass and markedly elevated serum alpha-fetoprotein (AFP) levels. Initially suspected as a germ cell tumour (GCT) due to age, site, and high AFP levels, a biopsy unveiled a high-grade malignant tumour characterised by undifferentiated monotonous cells. Although tumour cells exhibited positive AFP, the overall immunoprofile did not provide additional evidence to support GCT. Further work-up showed positive for NUT (nuclear protein in testis) immunostaining and the presence of BRD4-NUT1 fusion, confirming the diagnosis of NUT carcinoma. On radiology, there were extensive metastases to lungs, liver, vertebrae, and placenta. Despite aggressive chemotherapy, radiotherapy and immunotherapy, she did not respond to the therapies. Fortunately, her child was not affected by the carcinoma. This is the first case highlighting that thoracic lung primary NUT carcinoma can spread to the placenta and manifest with elevated serum AFP levels, potentially leading to misdiagnosis as GCT both clinically and pathologically.
Asunto(s)
Carcinoma , alfa-Fetoproteínas , Femenino , Humanos , Embarazo , alfa-Fetoproteínas/metabolismo , Proteínas que Contienen Bromodominio , Carcinoma/patología , Proteínas de Ciclo Celular , Proteínas Nucleares , Placenta/patología , Factores de TranscripciónRESUMEN
Hepatoid adenocarcinoma (HAC) of the mediastinum is a rare extrahepatic tumour that pathologically and morphologically resembles hepatocellular carcinoma. Extrahepatic HACs primarily occur in the stomach, ovaries, lung, gallbladder, pancreas and uterus. Patients with mediastinal HAC tend to be male smokers over forty years of age. Clinical symptoms of HAC are non-specific and varied in nature; therefore, diagnosis can be challenging and often delayed. Diagnostic investigations encompass haematological, radiological and histological assessment. Surgical resection is reserved for early-stage patients; however, since diagnosis may be delayed, most patients present with metastatic disease, for which the treatment of choice is platinum-based chemotherapy.
Asunto(s)
Adenocarcinoma , Carcinoma Hepatocelular , Neoplasias Hepáticas , Femenino , Humanos , Masculino , Mediastino/diagnóstico por imagen , Mediastino/patología , Adenocarcinoma/diagnóstico , Carcinoma Hepatocelular/patología , Páncreas/patología , Neoplasias Hepáticas/patologíaRESUMEN
Mucosa-associated lymphoid tissue (MALT) lymphoma is an uncommon extranodal low-grade B-cell lymphoma. Pulmonary MALT lymphomas originate from bronchial MALT and are also referred to as bronchial-associated lymphoid tissue lymphomas. MALT lymphomas of the lung are slow-growing tumours and usually present as asymptomatic chronic alveolar opacities visible on chest radiographs or with non-specific pulmonary symptoms. Here we described a case of a male patient in his early 50s with cough and chest pain for 4 years. His CT chest scan showed consolidation in the lingula and left lower lobe. Histopathology of the specimen obtained from cryobiopsy of the lung lesion showed a dense monomorphic lymphoid infiltrate, and immunohistochemistry confirmed the diagnosis of MALT lymphoma. The prognosis of pulmonary MALT lymphomas is good with >80% 5-year survival rates. This case highlights that MALT lymphoma should be considered as a differential diagnosis while evaluating cases with non-resolving consolidation.
Asunto(s)
Neoplasias de los Bronquios , Linfoma de Células B de la Zona Marginal , Neumonía , Humanos , Masculino , Linfoma de Células B de la Zona Marginal/diagnóstico , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Pulmón/patología , Neumonía/patología , Neoplasias de los Bronquios/patología , RadiografíaAsunto(s)
Aneurisma Falso , Embolización Terapéutica , Humanos , Aneurisma Falso/terapia , Arterias Bronquiales , RoturaRESUMEN
Management of cancer during pregnancy requires careful consideration of risks and benefits from maternal and fetal perspectives. For advanced lung adenocarcinomas, with no targetable driver mutations, there is evidence-based guidance on the use of carboplatin-paclitaxel chemotherapy after first trimester. In contrast, for epidermal growth factor receptor (EGFR)-mutated or anaplastic lymphoma kinase (ALK)-rearranged metastatic lung adenocarcinomas, there is a paucity of clinical data on the safety of EGFR and ALK tyrosine kinase inhibitors to mother and fetus for official guidelines to recommend the use of these otherwise-first-line therapies in pregnancy. Considering this knowledge gap, we present a case of a young gravida 1 para 0 (G1P0) woman who continued alectinib 300 mg oral two times per day for ALK-rearranged metastatic lung adenocarcinoma throughout all 36 weeks of her pregnancy and delivered a healthy baby at term via caesarean section (C-section).
Asunto(s)
Adenocarcinoma del Pulmón , Antineoplásicos , Carbazoles , Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Piperidinas , Embarazo , Humanos , Femenino , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Quinasa de Linfoma Anaplásico/genética , Neoplasias Pulmonares/patología , Cesárea , Proteínas Tirosina Quinasas Receptoras/metabolismo , Antineoplásicos/uso terapéutico , Adenocarcinoma del Pulmón/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/uso terapéutico , Receptores ErbB/genéticaRESUMEN
Patients on dialysis have limited treatment options for advanced lung cancer because some chemotherapeutic agents are unavailable due to renal dysfunction. A man in his 70s on peritoneal dialysis presented with persistent fever refractory to antibiotics for 2 weeks. Subsequent whole-body CT showed a 5 cm diameter mass in the right lower lobe of the lung with right-sided pleural effusion and osteolytic metastasis of the right iliac bone. The patient was diagnosed with squamous cell carcinoma (cT3N2M1b, stage IVB) harbouring the p.Gly719Ala point mutation on exon 18 of the epidermal growth factor receptor. The patient developed severe respiratory failure due to malignant lymphangitis after a bronchoscopy. He received 30 mg/day of afatinib, resulting in tumour shrinkage and recovery from respiratory failure. We advocate for aggressive screening of driver oncogenes in patients with lung cancer on dialysis, including those with squamous cell lung cancer.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias Pulmonares , Linfangitis , Insuficiencia Respiratoria , Masculino , Humanos , Afatinib/uso terapéutico , Linfangitis/tratamiento farmacológico , Linfangitis/etiología , Diálisis Renal , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/genética , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/tratamiento farmacológico , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/tratamiento farmacológico , Pulmón/patología , MutaciónRESUMEN
Intrathoracic extraskeletal Ewing's sarcoma (EES) is a relatively uncommon malignant tumour. Here, we present a scenario involving an adult man in his 20s with a large intrathoracic EES that manifested as a lung abscess. Preoperative diagnostic tests were inconclusive; hence, the patient underwent an exploratory thoracotomy for the excision of the mass. Histopathology revealed a small round blue cell tumour, and immunohistochemistry, along with fluorescence in situ hybridisation, confirmed the diagnosis of Ewing's sarcoma. Adjuvant chemoradiotherapy was recommended, but the patient did not comply. A year later, he presented with a recurrence of the intrathoracic mass and subsequently received adjuvant chemotherapy. Currently, he is in remission.
Asunto(s)
Absceso Pulmonar , Tumores Neuroectodérmicos Periféricos Primitivos , Sarcoma de Ewing , Sarcoma , Masculino , Adulto , Humanos , Sarcoma de Ewing/patología , Absceso Pulmonar/tratamiento farmacológico , Sarcoma/tratamiento farmacológico , Quimioterapia AdyuvanteRESUMEN
The management of patients with oligometastatic non-small cell lung cancer has undergone significant improvement in recent years. The combination of increase in sensitivity of diagnostic tests, development in systemic therapies, surgical techniques and radiotherapy allowing radical ablative treatment of metastases have significantly influenced the treatment of advanced lung cancer, mainly in the patients in which these treatment modalities converge.We report a rare case of a young patient with an oligometastatic lung adenocarcinoma with a single synchronous brain metastasis, who underwent aggressive locoregional and systemic therapies and is still in annual follow-up with excellent quality of life and progression-free survival of 164 months.
Asunto(s)
Adenocarcinoma del Pulmón , Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Humanos , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Calidad de Vida , Terapia CombinadaRESUMEN
Lung cancer is the second most common cancer diagnosed in men and women worldwide with the highest mortality. A rare site of metastases for lung cancer is the skin. Typically, the diagnosis is secure prior to developing cutaneous metastases. We present a case of a man in his mid-70s who presented to dermatology with cutaneous metastases. We outline the presentation, diagnostic workup and management of this case. We also review the literature of cutaneous metastases in lung cancer; highlighting the clinical need for a timely accurate diagnosis and the implication in terms of prognosis.
Asunto(s)
Neoplasias Pulmonares , Neoplasias Primarias Secundarias , Neoplasias Cutáneas , Masculino , Humanos , Femenino , Neoplasias Pulmonares/patología , Neoplasias Cutáneas/patología , Pronóstico , Piel/patologíaRESUMEN
Our case is an asymptomatic, non-smoking, East Asian woman in her 40s presenting with a solitary pulmonary nodule (SPN). On imaging, the 1.7 cm solid SPN located in the left upper lobe, was rounded in morphology and moderately fluorodeoxyglucose avid. The clinical pretest probability of malignancy assessed by risk prediction models such as Brock (19.1%), Mayo Clinic (56.2%) and Herder (51.4%) was discordant. She underwent a percutaneous CT-guided needle biopsy, establishing a diagnosis of pulmonary sclerosing pneumocytoma (PSP). PSP is a rare benign lung neoplasm with indolent growth characteristics that has been described predominantly in non-smoking women. Our case illustrates the limitations of applying existing risk prediction models in Asia where the epidemiology and biology of lung cancer differ significantly from the Caucasian derivation cohorts. Additionally, the risk models do not account for tuberculosis, which is endemic in Asia and can mimic malignancy. Non-surgical lung biopsy remains useful in minimising unnecessary thoracotomy.
Asunto(s)
Neoplasias Pulmonares , Hemangioma Esclerosante Pulmonar , Nódulo Pulmonar Solitario , Tuberculosis , Humanos , Femenino , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/patología , Pulmón/patología , Hemangioma Esclerosante Pulmonar/diagnóstico por imagen , Hemangioma Esclerosante Pulmonar/cirugía , Neoplasias Pulmonares/patología , Tuberculosis/patologíaRESUMEN
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumour of vascular origin with low to intermediate malignancy. Typical radiological finding on CT is multiple small nodules in bilateral lungs, and some will have punctate calcifications and pleural thickening. The diagnosis of PEH is confirmed by histopathological findings and positive immunohistochemistry staining. We report a case of a woman in her 50s with a medical history of lung adenocarcinoma. Later, regular chest CT during a routine cancer follow-up revealed multiple small pulmonary nodules and increased sizes of these nodules on serial images, initially misdiagnosed as multiple lung metastases. The histopathological diagnosis was made on a pulmonary wedge resection. Finally, PEH was diagnosed on the basis of positive immunohistochemical staining for CD31, ERF and TFE3. In the current study, the clinicopathological features and review of the literature were investigated. Our case highlights the importance of a histological diagnosis to avoid misdiagnosis.
Asunto(s)
Neoplasias Óseas , Neoplasias de la Mama , Hemangioendotelioma Epitelioide , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Neoplasias de Tejido Conjuntivo , Neoplasias Cutáneas , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/cirugíaRESUMEN
A woman in her mid-60s presented to the hospital due to a history of nausea, vomiting, shortness of breath, dyspnoea on exertion and polyuria. She was receiving medical therapy for advanced non-small cell lung cancer and recently initiated immune checkpoint inhibitor (ICI) immunotherapy. Investigations revealed lab results consistent with diabetic ketoacidosis (DKA), elevated cardiac biomarkers, multiple cardiac arrhythmias and reduced ejection fraction on transthoracic echocardiogram. Cardiac catheterisation showed non-obstructive coronary arteries.The patient was diagnosed with an ICI-associated myocarditis and type I diabetes due to recent initiation of the ICI durvalumab. She was treated with the institutional DKA protocol and received corticosteroid therapy for drug toxicity according to guidelines. She was discharged with marked improvement in symptoms. The patient had good recovery after discharge with further investigations showing improvement in her cardiac ejection fraction on cardiac MRI. She remains on medical therapy with an insulin regimen for diabetes management.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Diabetes Mellitus Tipo 1 , Cetoacidosis Diabética , Neoplasias Pulmonares , Miocarditis , Femenino , Humanos , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Miocarditis/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/complicaciones , Diabetes Mellitus Tipo 1/inducido químicamente , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/complicaciones , Cetoacidosis Diabética/complicacionesRESUMEN
A man in his 20s with a history of tobacco use presented with recurrent shortness of breath. He was hospitalised three times within the past 4 months for similar symptoms despite completing several courses of antibiotic therapy. In this presentation, he was afebrile with rhonchi and decreased breath sounds over the right lung. Chest CT demonstrated large consolidations in the right middle and lower lobes, worsened compared with 4 months prior. Infectious workup including bronchoscopy with bronchoalveolar lavage did not identify a causative organism. Testing for immune disease was negative. Transbronchial biopsy ultimately identified well-differentiated stage 3b lung adenocarcinoma with a KRAS G12C mutation. The patient was referred to oncology for outpatient follow-up and has since initiated chemotherapy. This case highlights diagnostic biases encountered in young patients and the utility of bronchoscopic biopsy for definitive diagnosis in presumed community-acquired pneumonia when the clinical outcome is not improving as expected.