An Unusual Radiologic Presentation of an Uncommon Bronchogenic Lung Carcinoma

Abstract

(CHEST 2005; 127:2264–2265) A 63-year-old woman presented with a short history (a few months) of persistent cough and mild shortness of breath. On further enquiry, she admitted to having a poor appetite, with an associated weight loss of approximately 4 kg over a period of 6 months. Clinical examination was unremarkable and did not reveal any signs of lung malignancy. A chest roentgenogram showed bilateral multiple pulmonary nodules (Fig 1). Blood tests for angiotensin-converting enzyme levels, systemic vasculitic screen, antineutrophil cytoplasmic antibody, and rheumatoid factor were normal. The C-reactive protein was mildly elevated at 52 mg/L. CT with IV contrast enhancement confirmed multiple nodular lesions within both lungs (Fig 2). The majority of the lesions had an unusual appearance, with a solid rim surrounding necrotic material and a more dense opacity at the center, reminiscent of an archery target. There was a larger cavitating lesion in the left lower lobe suggesting a primary tumor with multiple metastases. CT also revealed a mass in the left ovary. However, oophrectomy and subsequent histology revealed the lesion to be a benign ovarian fibroma. An open-lung biopsy was carried out to establish the diagnosis of the multiple lung nodules. At surgery, several visceral puckering nodules were identified. Histology of a lingular biopsy revealed multiple well-circumscribed tumors with central necrosis and cavitation. The tumors consisted of pleiomorphic epithelial cells with both glandular and squamous features, each of which comprised approximately 50% of the tumor and in keeping with primary adenosquamous carcinoma of the lung. She made an uneventful recovery from the surgical intervention and was referred for further treatment to her local oncologist.