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Lung Adenocarcinoma Mimicking Interstitial Lung Disease
Füsun Şahin1* and Nural Ören2
1Department of Chest Disease, University of Health Sciences/Yedikule Chest Disease and Thoracic Surgery Health Practice and Research Center, Istanbul, Turkey
2Department of Pathology, University of Health Sciences/Yedikule Chest Disease and Thoracic Surgery Health Practice and Research Center, Istanbul, Turkey
*Corresponding author: Füsun Şahin, Department of Chest Disease, University of Health Sciences/ Yedikule Chest Disease and Thoracic Surgery Health Practice and Research Center, Istanbul, Turkey
Published: 23 Dec, 2017
Cite this article as: Şahin F, Ören N. Lung Adenocarcinoma
Mimicking Interstitial Lung Disease. Clin
Oncol. 2017; 2: 1388.
Clinical Image
Lung adenocarcinoma can have highly variable clinical presentation, and range from a
small solitary nodule or limited number of nodules, to more extensive miliary disease, or diffuse
parenchymal infiltrates that are similar in appearance to bacterial pneumonia. The exact mechanism
of lung adenocarcinoma pathogenesis is still being investigated, however it appears that tumor
proliferation is eclipsed by noticeable inflammation and fibrosis that mimic a benign inflammation,
thus confusing physicians and consequently delaying diagnosis, as well as affecting quality of
patients’ life [1]. Lung adenocarcinoma shows specific staining patterns, which are useful in the
differential diagnosis of poorly differentiated neoplasms. These patterns are positive: TTF-1, napsin
A, CK 7, mucicarmine, PAS-D [2,3].
Our case was a 51-year-old male patient who was admitted to our outpatient clinic with
complaints of dry cough, shortness of breath with exertion and pain at the joints for the last 2
months. Postero-anterior chest X-ray showed bilateral infiltration in the lower zones (Figure 1).
Thorax computed tomography showed widespread frosted glass and interstitial thickening, more
prominent in the lower lobes in both lungs (Figure 2 and 3). No pathology was found in hemogram,
biochemistry and serological blood tests of the patient. In order to
investigate the etiology of interstitial lung disease, collagen tissue
markers were requested and all were negative. The patient underwent
bronchoscopy. Both bronchial systems are normal and open.
Transbronchial parenchyma biopsies were taken from the lateral and
posterior segments of the left lower lobe. Pathological consequences
of transbronchial biopsies performed by immunohistochemical
staining are "Pancytokeratin and TTF 1 (+). Lung adenocarcinoma,
which produces diffuse infiltration in the sub epithelial area under
the bronchial epithelium ". PET/CT was requested for body scanning.
SUV max: 3.2 interstitial involvement was observed in PET/CT,
especially in the bilateral lung subfields, and there was no pathological
involvement in other systems. The patient was sent to oncology
clinic with diagnosis of inoprabl lung adenocarcinoma. Our case
is presented because of its interesting radiological appearance and
emphasizing that it may be especially adenocarcinoma in the etiology
of interstitial lung diseases.
Figure 1
Figure 2
Figure 3
References
- Lantuejoul S, Colby TV, Ferretti GR, et al. Adenocarcinoma of the lung mimicking inflammatory lung disease with honeycombing. Eur Respir J. 2004; 24(3): 502-5.
- Shah RN, Badve S, Papreddy K, Schindler S, Laskin WB, Yeldandi AV, et al. Expression of cytokeratin 20 in mucinous bronchioloalveolar carcinoma. Hum Pathol. 2002; 33(9): 915-20.
- Raparia K, Ketterer J, Dalurzo ML, Chang YH, Colby TV, Leslie KO. Lung tumors masquerading as
- desquamative interstitial pneumonia (DIP): report of 7 cases and review of the literature. Am J Surg Pathol. 2014; 38: 921-924.