Lung Adenocarcinoma Presenting Research Articles

Primary Lung Adenocarcinoma as Secondary Malignancy After Bone Marrow Transplantation

SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Bone marrow transplant (BMT) recipients have a higher risk of developing secondary malignancies. Majority of secondary malignancies are cutaneous or oral mucosal cancers. Secondary cancers most often occur late, usually after 100 days from transplantation. Death caused by malignant neoplasm less than 5 years after transplantation is rare. We report a case of adenocarcinoma of the lung presenting as a secondary malignancy 71 days after bone marrow transplantation. CASE PRESENTATION: 54 year old Female in remission from Stage IV low grade follicular Non-Hodgkins Lymphoma underwent a matched sibling donor allogenic stem cell transplant for acute lymphoblastic lymphoma. She was treated with fludarabine and melphalan conditioning therapy as well as tacrolimus for graft vs host disease (GVHD) prophylaxis and presented 71 days following BMT as a transfer with dyspnea. Previous positron emission tomography (PET) showed resolving but persistent hypermetabolic ground glass opacifications in the right lower lobe thought to be resolving infectious/inflammatory process. Few months prior, computed tomography of chest revealed stable bilateral pulmonary micronodules without lymphadenopathy. On physical examination the patient was afebrile, tachypnic and tachycardic. Pulmonary auscultation revealed decreased right breath sounds and rhonchi. Chest X-ray revealed large right pleural effusion. The patient subsequently developed acute respiratory failure requiring intubation and diagnostic and therapeutic thoracentesis. Pleural fluid cytology was positive for adenocarcinoma consistent with lung primary. Despite best efforts, patient’s respiratory status continued to deteriorate and patient passed away in intensive care unit. DISCUSSION: Although BMT is a successful and recognized treatment option for malignant hematologic disorders, patients have increased risk for secondary malignancies. Conditioning chemotherapy, radiation therapy and immunosuppression therapy for GVHD increase secondary malignancy risk by mechanisms of direct organ toxicity and depletion of lymphocyte tumor regulation. Our patient developed a secondary malignancy as an unusual early complication of BMT after chemotherapy conditioning and GVHD prophylaxis with an aggressive primary lung adenocarcinoma. PET scan is known to poorly detect adenocarcinoma in situ and minimally invasive adenocarcinoma. Early stage malignancy may have been already present and overlooked. Further immunosuppression in context of BMT may have provided an environment for proliferation and rapid progression of disease. CONCLUSIONS: We report a rare presentation of lung adenocarcinoma as an early BMT complication. Due to profound immunosuppression, malignancy in BMT patients can present quickly and aggressively. Thorough follow up is needed for any resolving hypermetabolic states seen on PET scan. Reference #1: Bhatia, Smita, et al. “Solid cancers after bone marrow transplantation.” Journal of Clinical Oncology 19.2 (2001): 464-471. DISCLOSURE: The following authors have nothing to disclose: Tasneem Kaleem, Jordan Ray, John Moss, Laura Finn No Product/Research Disclosure Information

Acrometastasis as the Initial Presentation of Lung Adenocarcinoma in a Young Woman

Acrometastasis as the Initial Presentation of Lung Adenocarcinoma in a Young Woman

Analysis of histopathologic subtypes and CT characteristics of lung adenocarcinomas presenting as pure ground-glass nodule of 1 cm or less in maximal diameter

Objective To evaluate the correlations between CT features and histopathologic subtypes of lung adenocarcinomas presenting as pure ground-glass nodules (pGGN) of 1 cm or less in maximal diameter. Methods CT appearances, pathology and clinical data of 95 patients (97 lesions) who underwent curative resection of lung adenocarcinomas presenting as pGGN≤1 cm in diameter from March 2011 to February 2015 were retrospectively analyzed. Of the 97 lung adenocarcinomas, there were 19 atypical adenomatous hyperplasia (AAH) (19.6%), 31 adenocarcinoma in situ (AIS) (31.9%), 19 minimally invasive adenocarcinoma (MIA) (19.6%) and 28 invasive pulmonary adenocarcinoma (IPA) (28.9%). Fifty (51.5%) were preinvasive (AAH+AIS) and 47 (48.5%) were invasive (MIA+IPA). Lesion size and density were compared among pathologic subtypes using analysis of variance (ANOVA). Lesion size were compared between preinvasive and invasive lesions using 2-independent samples t-test. Lesion location, presence of bubble-like sign, air bronchogram, vessel changes, margin, and tumor-lung interface were compared among histopathologic subtypes using chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off point of size in discriminating preinvasive lesions from invasive lesions. Results Of the 97 lesions, there were no statistically significant differences among histopathologic subtypes in terms of lesion density, presence of bubble-like sign, air-bronchogram, and margin (P>0.05). Mean size of AAH, AIS, MIA and IPA was (0.72±0.19), (0.82±0.14), (0.84±0.11) and (0.85±0.16) cm respectively. There were statistically significant differences among histopathologic subtypes in terms of lesion size (F=3.16, P=0.028). The vessel changes occurred in 2 of AAH, 11 of AIS, 10 of MIA and 17 of IPA. There were statistically significant differences among histopathologic subtypes in terms of vessel changes (χ2=13.22, P=0.004). Lesions with clear tumor-lung interface were in 10 of AAH, 24 of AIS, 17 of MIA, and 26 of IPA. There were statistically significant differences among histopathologic subtypes in terms of tumor-lung interface (χ2=12.67, P=0.005). The optimal cutoff value of lesion size for differentiating preinvasive lesions from invasive lesions was 0.82 cm (sensitivity, 61.7%; specificity, 62.0%). Conclusion Lesion size, vessel changes, and lung-tumor interface may indicate the invasiveness of lung adenocarcinoma presenting as pGGNs of ≤ 1 cm in diameter. Key words: Lung neoplasms; Adenocarcinoma; Tomography, X-ray computed

Discrepancy of epidermal growth factor receptor mutation in lung adenocarcinoma presenting as multiple ground-glass opacities.

To identify epidermal growth factor receptor (EGFR) mutation status between different lesions in lung adenocarcinoma presenting as multiple ground-glass opacity (GGO) lesions and analyse its association with clinical characteristics. Seventy-eight patients with lung adenocarcinoma presenting as multiple GGO lesions were identified to investigate EGFR mutation in exon 18-21. Lesions with the largest size in diameter were defined as the primary lesions; the others were defined as the secondary lesions. One hundred and fifty-nine lesions of these patients were classified into pure GGO and mixed GGO by computed tomography scan images. The EGFR mutation rate in the patients was 48.7% (38 of 78). Patients with high frequency of EGFR mutation were females and non-smokers. The EGFR mutation rate of invasive adenocarcinoma was higher than that of atypical adenomatous hyperplasia/adenocarcinoma in situ and minimally invasive adenocarcinoma (P = 0.001). Although 19-deletion and L858R were the most common EGFR mutations, there was no difference of EGFR mutation in pathological subtypes of adenocarcinoma. Of the 38 paired lesions in patients harbouring EGFR mutation, the discordance rate of EGFR mutation was 92.1%. The study showed different EGFR mutational profiles in multiple GGO lesions, suggesting that lesions seem to arise as independent events. It would offer useful information for determining the appropriate treatment strategy for lung adenocarcinoma presenting as multiple GGO lesions.

Acrometástasis como presentación inicial de un adenocarcinoma de pulmón en una mujer joven

Acrometástasis como presentación inicial de un adenocarcinoma de pulmón en una mujer joven

Coexistent Primary Lung Adenocarcinoma and Mantle Cell Lymphoma: A Case Report

SESSION TITLE: Lung Cancer Case Report Posters II SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Mantle cell lymphoma (MCL) is a type of B-cell lymphoma, comprising 3-10% of non-Hodgkin lymphomas (NHL). Although there is a well-known increased risk for secondary malignancies after treatment in NHL survivors, the concomitant diagnosis of a primary lung cancer co-existent with lymphoma at initial presentation - is very rare. We present a case of concomitant primary lung adenocarcinoma with MCL. CASE PRESENTATION: A 55 year-old female, recently diagnosed with mantle-cell lymphoma (MCL), was referred after a pre-chemotherapy screening chest computed tomography scan (CT) identified severe emphysema, multiple indeterminate pulmonary nodules and a 1.7 x 1.1 cm, subpleural, thin-walled cavitary lesion in right the upper lobe (RUL). She was a 30 pack-year smoker with stable chronic bronchitis and sinusitis, scant hemoptysis, chills and 24-lb weight loss over 2 months. Tuberculosis testing was negative. Her mother had lung cancer. Physical examination was unremarkable. Our differentials included infection, malignancy and vasculitis. A bronchoscopy with lavage (BAL) revealed 87% macrophages and cultures grew 1+ Aspergillus flavus. Cytology and cytoplasmic antineutrophil antibodies were negative. CT chest at 2-month follow up showed stable pulmonary nodules and persistent RUL cavitary lesion. A VATS biopsy was performed to exclude infection prior to initiation of chemotherapy for MCL and revealed a lepidic predominant, well-differentiated adenocarcinomatous nodule (T1a) with foci of lymphoid infiltrate consistent with lung involvement by mantle cell lymphoma. DISCUSSION: Simultaneous presentation of primary lung adenocarcinoma with lymphoma is exceedingly rare. We found only one case report of incidental pleural involvement with MCL and primary lung adenocarcinoma [1]. Barista et al. [2] reported a series of patients with MCL who had an increased predisposition to second primary tumors at diagnosis (mostly urological). CONCLUSIONS: Our case demonstrates two different populations of tumor cells within a subpleural lung nodule without any pleural involvement. The nature of this association is not clear however it underscores the importance of surveillance for synchronous malignancies in patients with newly diagnosed MCL. Reference #1: Hatzibougias, D., et al., A rare tumoral combination, synchronous lung adenocarcinoma and mantle cell lymphoma of the pleura. World J Surg Oncol, 2008 Reference #2: Barista, I., et al., Is there an increased rate of additional malignancies in patients with mantle cell lymphoma? Ann Oncol, 2002. DISCLOSURE: The following authors have nothing to disclose: Masooma Aqeel, Nevin Uysal-Biggs, Timothy Fenske No Product/Research Disclosure Information

Gastric and Breast Metastasis From Lung Adenocarcinoma: A Case Report

Introduction: Lung cancer is one of the most commonly diagnosed cancer and the leading cause of cancer mortality worldwide. Lung adenocarcinoma constitutes nearly 40 % of primary lung cancers. Its main metastatic sites are the liver, brain, adrenal glands, and bone. Metastasis to the gastrointestinal tract is infrequent, particularly to the stomach. Most cases of gastric metastasis are asymptomatic and are usually present in the submucosa. Case report:A 53 year-old female presented to the Emergency Department with severe epigastric pain of 4-day duration. The patient underwent a CT of the chest, abdomen and pelvis which showed a lobulated speculated 3 cm mass at the upper lobe of the left lung, a 3.3 cm mass in the tail of the pancreas, a 3.1 cm mass medially in the left breast, and extensive deposits in the superior mediastinum, at the right axilla, in the left upper lobe, precaval lymphadenopathy and multiple subcutaneous nodules highly suspicious for metastasis. To further evaluate the epigastric pain, the patient underwent an EGD which showed a 1.5 cm protruding subepithelial lesion with a central ulcer. The nodule was biopsied at the edges of the ulcer. Histological examination showed tumor cells consistent with adenocarcinoma. The tumor cells showed immunoreactivity with CK7, Thyroid transcription factor 1 (TTF-1) and Napsin A. They were negative for CK 20. The immunohistochemistry profile was most compatible with a primary lung neoplasm. A tissue biopsy was also obtained from the breast mass with similar immunohistochemical staining pattern further supporting lung as the primary site. A bone scan showed osseous metastasis. Conclusion: We report a rare presentation of lung adenocarcinoma with metastasis to both stomach and breast among other sites. Another unique finding is the symptomatology of the gastric metastasis as it presented with acute epigastric pain most likely due to the ulceration overlying the subepithelial metastatic gastric nodule. Gastrointestinal manifestations in cancer patients is usually attributed to chemotherapy but it could be due to gastrointestinal metastais as well.Figure 1Figure 2Figure 3

Papillary Thyroid Cancer and Lung Adenocarcinoma Presenting as Two Primary Malignancies in a Patient with Symptomatic Goiter.

In rare instances, patients may be diagnosed with two different primary malignancies. Though such synchronous malignancies have been documented in sporadic case reports, the overwhelming majority of malignancies involving multiple organs can be attributed to a primary source. Papillary thyroid carcinoma and lung adenocarcinoma are rarely diagnosed within the same year. Our case report presents a patient who was diagnosed with these two malignancies during her same hospital visit. Biopsies results proved that the two malignancies were in fact separate entities and not a consequence of metastasis from a primary source.

Case report: unusual discovery and first presentation of a metastatic lung adenocarcinoma in a uterine leiomyoma

Lung adenocarcinoma is the most common subtype of lung cancer in most countries with metastases commonly occurring in the brain, bones and liver. Uterine metastasis is uncommon especially when restricted to lung adenocarcinomas alone and even more so when they occur as isolated metastatic foci in leiomyomas. We present a case of an isolated metastasis from a poorly differentiated lung adenocarcinoma to a uterine leiomyoma in a 59-year-old Chinese female which was suspected radiologically to be a sarcomatous transformation of the leiomyoma. This occurred in the absence of any other known primary or metastasis other than her original lung adenocarcinoma. In addition, a short review on the usefulness of TTF-1 as a marker of identifying metastatic pulmonary neoplasm is also presented.

Crouching Tiger, Hidden Dragon: Lung Adenocarcinoma Presenting as an Obstructive Jaundice

Introduction: Metastatic lesions of the pancreas are uncommon compared with primary pancreatic cancer and account for approximately 2% of all pancreatic malignancies. The clinically evident pancreatic metastasis is rare and mostly found during autopsy. Pancreas is an uncommon site for lung adenocarcinoma metastasis. Obstructive jaundice due to extrahepatic biliary obstruction from synchronous pancreatic metastatic disease from lung cancer has rarely been reported. Thus, when encountering a focal lesion in the pancreas, high index of suspicion is necessary for possibility of pancreatic lesion being a metastatic lesion. A 65-year-old female with past medical history significant for breast cancer treated with lumpectomy, chemotherapy, and radiation treatment 14 years ago presented to the hospital complaining of itching and yellowish skin discoloration, occasional epigastric pain, and an episode of vomiting. She denied fever, weight loss, hematemesis, or melena. The patient was reported to be a nonsmoker and nonalcoholic. Systemic examination was remarkable for scleral icterus and mild epigastric tenderness. Laboratory workup was significant for amylase of 272 IU/L (23-85), lipase of 600 U/L (0 to 160 U/L), total bilirubin of 10.5 mg/dL (0.3 to 1.9), ALP of 505 IU/L (44 to 147), AST of 154 IU/L (5-40), ALT of 245 IU/L (7-56). Computed tomography (CT) of the abdomen and pelvis revealed a 3 x 3 cm pancreatic head mass with proximal common bile duct (CBD) and pancreatic duct dilatation to 13 mm and 7 mm, respectively. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an ampullary mass, which on biopsy was inconclusive but suspicious of malignancy. This was followed by percutaneous external biliary drain placement for decompression of the biliary tree as we were unable to place the stent endoscopically. PET-CT scan revealed large metabolic uptake in the right lower lobe of the lung and in the pancreatic head with multiple lymph nodes in the mediastinum and hilum. This lead to a CT-guided biopsy of the 2.8 cm subcarinal lymph node, which illustrated poorly differentiated lung adenocarcinoma. Finally, an EUS/ERCP-guided plastic stent was placed and biopsy of the pancreatic mass confirmed the diagnosis of adenocarcinoma with lung being the primary site. Finally the diagnosis of stage 4 non-small cell lung cancer was established. The patient is following the oncology clinic and is currently receiving chemotherapy. The plastic stent was later replaced by a metallic stent.

A Pragmatic Dilemma: A Case of Lung Adenocarcinoma Presenting as Upper and Lower Extremity Venous Thromboembolism and Protein C and S Deficiency

A Pragmatic Dilemma: A Case of Lung Adenocarcinoma Presenting as Upper and Lower Extremity Venous Thromboembolism and Protein C and S Deficiency

蜂巣肺様陰影を呈した高分化型肺腺癌の1例

蜂巣肺様陰影を呈した高分化型肺腺癌の1例

An ALK translocation positive carcinoma of the lung presenting as uremia due to bilateral

We describe an unusual presentation of metastatic lung adenocarcinoma as malignant retroperitoneal fibrosis (MRPF). The diagnostic challenge, due to the small solitary lung mass and absence of a discrete retroperitoneal mass, was overcome by diagnostic laparoscopy. Molecular analysis of tissue acquired was positive for ALK gene rearrangement. Treatment of the patient with crizotinib reversed MRPF. He was weaned off the nephrostomy tubes and is with stable renal function 11 months after diagnosis.

A case of myocardial metastasis from lung adenocarcinoma presenting as cerebral infarction

Introduction: Myocardial metastasis from lung cancer is rarely found in antemortem settings. Herein we present a case of myocardial metastasis from lung adenocarcinoma presenting as cerebral infarction. Case Report: A 78­year­old Japanese female (non­smoker) who had been diagnosed with poorly differentiated lung adenocarcinoma suddenly complained of weakness in the left hand on a regular follow­up visit. Brain non­contrast­ enhanced computed tomography (CT) scan showed no abnormality. Electrocardiography (ECG) showed abnormal Q waves, ST­segment elevation, and inverted T waves in leads II, III, and aVF that had not been demonstrated previously. The results of brain CT scan and symptoms were strongly suggestive of cerebral infarction. Brain magnetic resonance imaging (MRI) with diffusion­weighted imaging performed 5 days after admission showed a small, acute infarct on a knob on the precentral gyrus. Transthoracic echocardiography performed to detect cardiac sources of embolism revealed an intracardiac mass. Cardiac 18F­fluoro­deoxy­glucose positron emission tomography (18F­FDG PET)/CT scan demonstrated increased uptake in the mass. After the patient died, autopsy revealed many metastatic lesions of various sizes accompanied by thrombi on the surface of the ventricular myocardium. Conclusion: Cardiac 18F­FDG PET/CT was useful for diagnosing myocardial metastasis in our patient. The possibility of cardiac metastases should be considered in patients with lung cancer in the event of sudden cerebral infarction.

Lung Adenocarcinoma Presenting with WDHA Syndrome and Marie-Bamberger Syndrome: A Case Report

Watery diarrhea, hypokalemia, and achlorhydria (WDHA syndrome), also known as Vermer-Morrison syndrome or vipoma syndrome, was first reported by Verner and Morrison in 1958. It is characterized by watery diarrhea, hypokalemia and achlorhydria (or metabolic acidosis), most commonly associated with pancreatic islet cell tumors in adults.

Lung Adenocarcinoma Presenting with Diffuse Multiloculated Cystic Lesions

Lung Adenocarcinoma Presenting with Diffuse Multiloculated Cystic Lesions

Adenocarcinoma of Lung Presenting as Diffuse Nodular Pleural Thickening With Lung Entrapment Mimicking Mesothelioma: A Case Report

SESSION TYPE: Cancer Student/Resident Cases

Bulky Locally Invasive Adenocarcinoma of Lung Presenting With Hiccups in an HIV Patient

Bulky Locally Invasive Adenocarcinoma of Lung Presenting With Hiccups in an HIV Patient

Metastatic Lung Adenocarcinoma Presenting as Thumb Pain

Metastatic Lung Adenocarcinoma Presenting as Thumb Pain

Lung Carcinoma Presenting With Pathologic Femur Fracture and False-Positive Pregnancy Test Result

β-Human chorionic gonadotropin (βhCG) assays are routinely used to test for pregnancy. However, βhCG may be elevated in conditions other than pregnancy. We describe a case of metastatic lung adenocarcinoma presenting with a pathologic femur fracture and a false-positive urine pregnancy test. Lung cancer is the most common nongestational malignancy that produces βhCG among reproductive-age women. Emergency physicians should consider this rare cause of a positive pregnancy test result in women who deny recent sexual intercourse, especially if the patient is older than 40 years, has a history of tobacco use, or presents with respiratory complaints.