Benign Bronchial Cells Research Articles

METASTATIC PANCREATIC CANCER MASQUERADING AS INTERSTITIAL LUNG DISEASE

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Pancreatic cancer is often metastatic at presentation and occasionally presents with predominantly respiratory symptoms that can lead to further delays in diagnosis. CASE PRESENTATION: A 78 year old female with a history of breast cancer in remission presented with persistent cough for 3 months. She was found to have bilateral basilar ground glass opacities on CT chest [Image 1]. She had bronchoscopy with bronchoalveolar lavage and transbronchial biopsy that showed a neutrophil and macrophage predominant lavage with negative bacterial, fungal and acid fast cultures and benign bronchial cells and chronic inflammation on biopsy. She was treated for a presumed bacterial pneumonia. A myositis and autoimmune panel were normal. A repeat CT chest in 1 month showed worsening bilateral opacities and she was started on prednisone for presumed cryptogenic organizing pneumonia [Image 2]. She unfortunately had worsening dyspnea, worsening hypoxia requiring supplemental oxygen and again worsening bilateral opacities on a repeat CT scan 2 months later [Image 3]. She underwent surgical lung biopsy which was concerning for adenocarcinoma with mucinous and lepidic features. Staining was concerning for malignancy of gastrointestinal origin. A PET-CT scan revealed a pancreatic tail mass and a CA 19-9 was markedly elevated concerning for metastatic pancreatic adenocarcinoma. She unfortunately developed a post-surgical pneumothorax requiring a prolonged hospitalization and further deconditioning. She was not a candidate for aggressive treatment options due to decreased pulmonary reserve and poor performance status. DISCUSSION: In rare circumstances, metastatic cancers, particularly pancreatic adenocarcinomas, can present with acinar and lepidic spread of tumor which can mimic interstitial lung disease, rather than a nodular or lymphangitic presentation [1]. This can confound the diagnosis and lead to a diagnostic delay. Early consideration of surgical lung biopsy may need to be considered in cases where a clear etiology of interstitial lung disease is not evident in order to prevent further delays in diagnosis which may limit treatment options [2]. CONCLUSIONS: We present a case of metastatic pancreatic cancer presenting initially with dyspnea and chest imaging suggestive of interstitial lung disease. Surgical lung biopsy was able to confirm the diagnosis, but unfortunately not until the patient experienced a significant decline in her performance status which limited her treatment options. Early diagnosis is imperative for effective treatment of pancreatic cancer, and acinar and lepidic spread of tumors should remain in the differential for persistent ground glass opacities on radiography. Reference #1: Ozkan E, Balachandran A, Bhosale PR, Tamm EP, Marcal LP, Szklaruk J. Pictorial essay: multimodality imaging of metastases from pancreatic ductal adenocarcinoma. Clin Imaging. 2010; 34(4):277-87 Reference #2: Heraudeau A, Ricordel C, Sale A, et al. Interstitial lung disease and pancreatic cancer: Series of two cases. Rev Mal Respir. 2018 Jan;35(1):78-82 DISCLOSURES: No relevant relationships by Nihal Patel, source=Web Response No relevant relationships by Michael Wert, source=Web Response

HnRNP B1 expression in benign and malignant lung disease.

Evidence is accumulating to suggest that hnRNP B1 expression may be a useful tool in the early diagnosis of lung cancer. This study examined the immunohistochemical expression of hnRNP B1 in archived sections of resected lung cancers and compared the patterns of expression with those seen in similar archived sections of non-neoplastic lung. Particular attention was paid to the expression of hnRNP B1 in the benign bronchial cells in both cases, to establish if overexpression of this protein in respiratory epithelial cells is specific for malignancy. Nineteen cases of different types of non-small cell carcinoma were examined (eight squamous cell, six adenocarcinomas, two carcinosarcomas, two undifferentiated large cell carcinomas, and one mucoepidermoid carcinoma) and compared with sections from 16 open lung biopsies (three cases of cryptogenic fibrosing alveolitis, two cases of sarcoidosis, two cases of organizing pneumonia, and one case each of tuberculosis, extrinsic allergic alveolitis, non-specific interstitial pneumonitis, pneumocystis pneumonia, aspergilloma, respiratory bronchiolitis-interstitial lung disease, mineral dust disease, Sjögren's syndrome and systemic sclerosis vascular variant). All the tumours showed positive staining, with the vast majority, 16/19 (84%), showing strong diffuse nuclear staining. The background cells of these cases showed positive staining in alveolar macrophages, lymph node germinal centres, bronchial mucous glands, and bronchial epithelial cells. No significant difference was seen in the percentage of positive bronchial epithelial cells in bronchi adjacent to the tumour compared with the resection margins. In the benign lung cases, positive bronchial epithelial cells were seen in a small percentage, 3/16 (18%), of cases, but the majority of cases showed no or very focal staining. The levels of expression between benign epithelial cells of malignant cases, compared with benign, showed a significant difference when the staining was assessed in percentage of positive nuclei (p = 0.001, Fisher's exact test). The results confirm that hnRNP B1 is widely expressed in a range of lung carcinomas; that expression is seen in benign bronchial epithelial cells and inflammatory cells; and that expression in background bronchial epithelial cells appears to be higher in malignant than in benign lung disease. It is feasible that this biomarker may be of use in the detection of early lung cancer, provided that levels of expression can be accurately quantified.