Dr. Mothi ganesh - Bronch...

Bronchovascular Carcinoma - A Case Presentation

Case:

• A 65-year-old male, an accountant by profession and a non-smoker, presented to the Respiratory Medicine OPD
• C/O Cough and expectoration for the past 9 months.
• The patient had diabetes mellitus type 2 and was taking his medicine on a regular basis.
• The patient was evaluated for "non-resolving pneumonia" for a time span of one vear.
Antibiotic courses did not provide the patient any sort of relief and there was no change in the size of the lesion
> O/E: T-afebrile, Pulse rate 96/min, Respiratory Rate of-20/min, BP-122/80 mmHg,Sp02 of 98% on RA. Breath sounds - reduced throughout the right interscapular area.
> Sputum for AFB - mucoid negative. 
[Fig-1]: Chest X-ray-non homogenous opacity

[Fig-2]: CECT thorax -ill-defined consolidation with surrounding Ground Glass
Opacities (GGOL with interlobular septal thickening in the anterior segment of the right upper lobe of size 6.7×4.1×5.2 cm, with postcontrast enhancement

[Fig-3]: PET-CT scan-mild-Flourodeoxy Glucose activity in the right upper lobe
Likely primary

CYTOLOGY:
A CT-Guided biopsy - HE report shows columnar cells containing mucin lining the respiratory spaces in lepidic fusion without invading stroma suggesting bronchoalveolar carcinoma (H&E stain, 400X). (Fig-4)
IHC:
Tumor cells are diffuse and strongly positive for
CK7. TTF1. and Napsin A and negative for CK20 suggesting primary well differentiated mucinous adenocarcinoma of the lung [Fig-5].

Treatment:
Chemotherapy with cisplatin (90 mg) and Pemetrexed(800 mg) in cycles and radiotherapy

Conclusion:
• Bronchoalveolar carcinoma, due to its resemblance with pneumonia the diagnosis and treatment are often delayed
• Hence, biopsy must always be considered when a pneumonia like picture does not respond to antibiotic medication.

References:
Travis WD, Garg K, Franklin WA, Wistuba II, Sabloff B, Noguchi Met al.
Bronchioloalveolar carcinoma and lung adenocarcinoma: the clinical importance and research relevance of the 2004 World Health Organization pathologic criteria. J Thorac Oncol. 2006;1(9 Suppl): S13-S19.' Download the MediSage app to read  https://dl.mymedisage.com/xtUiLcRG6ZKEeKit6