CIRUGÍA DE CÁNCER DE PULMÓN EN ESTADIO TEMPRANO EN LESIÓN CAVITARIA QUE SIMULABA ABSCESO PULMONAR, REPORTE DE CASO.

Abstract

Introduction Pulmonary cavitations are defined as a space filled with air, within a pulmonary area of consolidation, a mass or a nodule, they are produced by the expulsion or drainage of the necrotic part of the lesion through the bronchial tree. The most frequent causes are infectious by mycobacteria as in tuberculosis, or bacteria as in necrotizing pneumonia, pulmonary abscesses, although on rare occasions, it can also present in pulmonary embolism with infarction. Neoplasms should always be suspected, being squamous cell carcinoma the one that has been related to a greater extent to pulmonary cavitary lesion, and to a lesser extent to adenocarcinoma. Other less frequent causes are granulomatosis with polyangiitis, lymphomas, pneumoconiosis, silicosis. Case description Patient with respiratory symptoms of one year of evolution, characterized by cough with sporadic yellowish expectoration plus chest pain, in 03/2020 is accompanied by hemoptysis and progressive dyspnea, without weight loss or fever, private physician indicates antibiotic with partial improvement; On 08/2020 she presented hemoptysis, she went to the doctor again and requested a tomographic study in which she showed evidence of pulmonary cavitation associated with consolidation, a new antibiotic scheme was administered, without improvement, and she went to this clinic on 11/2020. New tomographic study showed cavitation with thick walls, preserved renal and hepatic function, infectious profile and negative immunological tests. Bronchoscopy with BAL cytology positive for malignancy, simple and contrasted body tomography and PET SCAN were indicated, showing hypermetabolic mass in the right lower lobe, with no evidence of distant metastasis or affected lymph nodes. Pulmonary function is assessed for surgical resolution, being adequate, right lower lobectomy is performed, showing free surgical edges, with negative regional nodes for malignancy, with pathology reporting lung adenocarcinoma, pathological staging T3N0, and according to the imaging study M0, determining stage IIB. He required chemotherapy and adjuvant radiotherapy. Conclusion Lung cancer symptomatology can be silent and mainly non-specific, in the study by Bradley et al. addressing lung cancer risk by symptomatology and by chest radiography, they conclude that chest radiography has limited sensitivity and that only hemoptysis has a statistically significant predictive value for malignancy. In relation to cavitated lesions as a presentation in lung cancer, they are evidenced in 5 to 15% of all patients. Within primary neoplasms the frequency with which we can observe cavitation of the lesion is related to the histological subtype, it is more frequent in squamous carcinomas (9-38%), rarer in adenocarcinomas (6-15%) and large cell carcinoma, and practically rules out small cell carcinoma. As conclusions, multidisciplinary management allows adequate orientation in both the diagnostic and therapeutic algorithm of patients, which will improve patient survival.