Non-Resolving Lung Infiltrate: A Rare Case of Papillary Adenocarcinoma of the Lung

Nikhil Madan,Carolina Pinzon Escobar,Vipul Patel

doi:10.36648/2471-8041.5.3.128

Abstract

Lung carcinoma is one of most common and leading cause of cancer related mortality in United States. The main sub-types of lung cancer are non-small cell lung carcinoma (NSCLC) and small cell carcinoma (SCLC). About 85% of lung cancers are of the non-small cell type, of which more than 50% are adenocarcinomas. Primary papillary adenocarcinoma (PA) is a subtype of adenocarcinoma with predominance of papillary structures that replace the underlying alveolar architecture supported by fibro-vascular cores with complicated secondary and tertiary branches. PA is a relatively rare type that can present a diagnostic challenge when it presents as a non-resolving infilitrate as seen in this case. It is more common in woman and non-smokers. The subtype of adenocarcinoma is key factor for therapeutic choice of chemotherapy. The case reviewed here is a rare presentation of a middle aged chronic smoker Man with past medical history of chronic obstructive pulmonary disease (COPD) who was treated several times for recurrent episodes of worsening dyspnea attributed to an infectious etiology, but without any significant improvement which led to further testing and trans-bronchial biopsy which reveled PA of the lung. Tissue diagnosis is therefore warranted in patients with a non-resolving lung infiltrate.

Highlights

A non-resolving infilitrate is encountered in clinical practice not uncommonly
papillary adenocarcinoma (PA) is distinct clinicpathologic entity with considerably worse morbidity and mortality compared to other sub-types of adenocarcinoma [4]
In May 2004, two studies showed that the presence of somatic mutations in the kinase domain of epidermal growth factor receptor (EGFR) strongly correlates with increased responsiveness to EGFR tyrosine kinase inhibitors in patients with non-small cell lung cancer [8,9]

Summary

Introduction

A non-resolving infilitrate is encountered in clinical practice not uncommonly. It does present a diagnostic dilemma for the clinician as the differential diagnosis is vast. Primary papillary adenocarcinoma (PA) is an uncommon invasive form of lung cancer where papillae replace the underlying alveolar architecture. Patient was treated extensively for pulmonary infections empirically without appropriate clinical response This is a 62-year-old man who was referred to our institute for further evaluation of a non-resolving lung infiltrate. He initially presented to the outside hospital with episodic dyspnea on exertion and cough with small amount of yellow sputum production for about two months duration. Spirometry showed moderate reduction in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) with significant obstructive pattern He had severe reduction in diffusion capacity noted on study performed using carbon monoxide.

Discussion

Findings

Conclusion