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Scientific Letter
Lung Adenocarcinoma Presenting as a Multiple Cavitary Disease
Adenocarcinoma pulmonar que se presenta como una enfermedad cavitada múltiple
Luís Carretoa,
Corresponding author
luis.carreto@hff.min-saude.pt

Corresponding author.
, Carlos Alvesa, João Euricob, Paulo Cavinhob
a Pneumology Department, Hospital Professor Doutor Fernando Fonseca E.P.E, Portugal
b Cardiothoracic Surgery Department, Hospital Santa Marta, Centro Hospitalar Lisboa Central E.P.E, Portugal
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        "titulo" => "Adenocarcinoma pulmonar que se presenta como una enfermedad cavitada m&#250;ltiple"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thoracic CT scan of a 62 year-old women with stage IV lung adenocarcinoma&#44; showing multiple bilateral thin-walled air-filled cavities with a diffuse distribution&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Various diseases may present as cavitary pulmonary nodules&#44; ranging from benign to malign diseases&#46; A cavity is defined in Fleischner glossary as &#8220;a gas-filled space&#44; seen as a lucency or low-attenuation area&#44; within pulmonary consolidation&#44; a mass&#44; or a nodule&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The thickness of the cavity wall and symptoms may help differentiate&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> We present a case of a patient with metastatic adenocarcinoma of the lung presented as a multiple cavitary disease&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 62 year-old female&#44; former smoker &#40;30 pack&#47;year&#41;&#44; with no relevant clinical history&#44; presented with chronic dry cough&#44; fatigue and weigh loss for 5 months&#46; Her chest computed tomography &#40;CT&#41; scan showed multiple bilateral thin-walled air-filled cavities&#44; with a diffuse distribution but basal predominance&#44; round shaped but some of them with irregular borders&#44; associated with centrilobular nodules &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; She underwent flexible videobronchoscopy with no endoscopic abnormalities and a negative bronchoalveolar lavage &#40;both cytological and microbiological analysis&#44; including nucleic acid amplification test &#40;NAAT&#41; for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>&#41;&#46; Apart from positive antinuclear antibodies &#40;ANA&#41; and anti-Sj&#246;gren&#39;s-syndrome-related antigen A &#40;SSA&#41;&#44; blood analysis was irrelevant&#46; The patient was then submitted to a surgical lung biopsy of the right lower lobe&#46; Histological analysis of the biopsy showed multiple areas of mucinous adenocarcinoma&#46; She was diagnosed with stage IV lung cancer and treated accordingly with chemotherapy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Cavitation has been reported in up to 22&#37; of primary lung cancer cases&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> It is believed that this phenomenon occurs due to rapid tumor growth that exceeds the blood supply with resultant central necrosis&#46; Usually these cavitations have irregular or spiculated inner or outer margins&#44; as well as thicker walls&#44; but it has been found that some patients with lung cancer might also present with cysts or cavities with thin walls&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> which might lead to a misdiagnosis of a benign disease and delayed treatment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The acute or chronic onset of symptoms might help narrowing the differential diagnosis&#59; however&#44; lung cancer might also present with acute symptoms of a concomitant a respiratory infection and lung abscess might be presented with chronic symptoms of weight loss and anorexia&#46; There are&#44; however&#44; some radiologic findings that can help&#58; rim enhancement of the walls on contrast-enhanced CT scan suggests abscess and satellite nodules might occur in infectious etiologies&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Traditionally&#44; squamous cell carcinoma was the most frequent histology found in cavitated tumors&#59; however&#44; an increasing number of adenocarcinomas have been found to form cavitations&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Despite cavitation of primary lung cancer being relatively common&#44; cavitation of lung metastases is infrequent&#46; Only 4&#37; of lung metastases cavitate&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> which makes this case a rare presentation of stage IV lung adenocarcinoma&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis of a cavitary lung disease is challenging&#46; Radiologic findings may help distinguish benign from malign disease&#44; but a high suspicion of neoplasm is essential for preventing misdiagnosis&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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