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L.C. Subia
Author of
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-062 - Primary Lung Adenocarcinoma in the Young with Multiple Metastases: An Autopsy Report of 2 Cases (ID 8782)
09:00 - 09:00 | Author(s): L.C. Subia
- Abstract
Background:
Lung cancer is the leading cause of cancer-related deaths worldwide with tobacco use and increasing age as the strongest risk factors. We report 2 uncommon cases of primary pulmonary adenocarcinoma with multiple metastases in young non-smoker, immunocompetent males diagnosed post-mortem.
Method:
Tissue sections taken during autopsy were fixed in 10% neutral buffered formalin and embedded in paraffin. Some 5-micrometer sections were stained with hematoxylin-eosin, mucicarmine and immunohistochemical stains for morphologic and immunohistochemical evaluation.
Result:
Case 1: The patient was a 23 year-old, non-smoker male, non-reactive with HIV test, who presented with several months of shortness of breath, exertional dyspnea and easy fatigability. Imaging studies revealed massive pleural and pericardial effusion and was admitted as a case of tuberculosis. Pericardial biopsy and cytology of pericardial and pleural fluid showed atypical cells. The patient’s condition progressed rapidly and he eventually died. On autopsy, the thoracic cavity was filled with a mass occupying the right hemithorax. The mass was a moderately differentiated adenocarcinoma that extensively infiltrated the left lung and other contiguous structures like the pericardium, ventricular wall, aorta and pulmonary trunk and peritoneal surface of the liver. IHC revealed the tumor cells as positive for CEA and CK7, but negative for CK20 and TTF-1. Mucicarmine stain was positive. Case 2: The patient was a 33-year old, non-smoker male, non-reactive with HIV test, who presented with progressive difficulty of breathing for 2 years and managed as a case of tuberculosis and pneumonia in a hospital and subsequently referred and admitted at our institution. Chest x-ray showed diffuse extensive hazy reticular densities and confluent densities in the left lung and managed as tuberculosis. His condition deteriorated rapidly and he eventually expired. Post-mortem examination revealed a mass located in the carina with several metastatic deposits in the mediastinum, peritoneum and retroperitoneum. The mass was a moderately differentiated adenocarcinoma of bilateral lung with extension to contiguous structures like the great vessels, pericardium, esophagus, distal trachea and with distant metastasis to adrenals. IHC revealed the tumor cells as positive for CEA, CK7 and TTF-1, but negative for CK20. Mucicarmine was focally positive.
Conclusion:
These cases are uncommon presentation of disseminated lung cancer. Clinicians should be wary in the clinical diagnosis of young, immunocompetent, non-smoker patients who present with difficulty of breathing and effusion. In such cases, a diagnosis of tuberculosis in a country with a high TB burden, might mask a greater evil in the form of an underlying lung malignancy.
