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Weekly Chest CasesArchive of Old Cases

Case No : 440 Date 2006-04-03

  • Courtesy of Jeong Geun Yi, MD. / Konkuk University Hospital, Seoul, Korea
  • Age/Sex 68 / M
  • Chief ComplaintExertional dyspnea
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Squamous Cell Carcinoma in A Patient with Idiopathic Pulmonary Fibrosis
Radiologic Findings
Chest radiograph shows reticular densities, most severe in lower lung fields. HRCT scans show septal thickenings, ground glass opacity, with honeycombing in subpleural, periphery of both lower lobes. There is an elongated shaped nodular density or consolidation-like mass in lateral portion of right lower lobe periphery, subpleural region. Histologic specimen of this lesion proved as squamous cell carcinoma.
Brief Review
Idiopathic pulmonary fibrosis (IPF) is known to be associated with an increased risk of developing lung cancer. The individuals with lung cancer associated with IPF are predominantly male smokers, and their cancer is usually located in the peripheral lung areas dominantly lower lobes. Chest radiographic features of lung cancer developing with IPF have been described as nodular or linear densities that are sometimes accompanied by honeycomb formation. Lee et. al reported that typical CT findings of lung cancer were ill-defined consolidation-like masses at the peripheral portion, which were located mainly in the lower lobe. Conversely, Sakai et al & Kishi et al showed that most lung cancer associated with diffuse pulmonary fibrosis consisted mainly of IPF, was round, nodular or lobulated in shape with sharp margins, and was located in the peripheral area of honeycombing.

57 histologically proved bronchogenic carcinomas were 35 squamous cell carcinomas, 12 small cell carcinomas, and 10 adenocarcinomas according to Sakai et al. and Lee et al reported that 56 % were squamous cell, 21% were adenocarcinomas, and 19% were small cell lung carcinomas.

Usual CT findings of such lung cancer with IPF are well-defined nodules with lobulation in the peripheral subpleural areas inside or adjacent to the fibrosis. Because it is difficult to find a small-sized lung cancer associated with IPF by chest radiography, routine use of CT is recommended for early detection of lung cancer as well as for evaluating serial changes in IPF.
References
1. Lee HJ, Im J-G, Ahn JM, et al. Lung cancer in patients with idiopathic pulmonary fibrosis: CT findings. J Comput Assist Tomogr. 1996;20:979-982

2. Sakai S, Ono M, Nishio T, et al. Lung cancer associated with diffuse pulmonary fibrosis: CT-pathologic correlation. J Thorac Imaging. 2003;18:67-71

3. Kishi K, Homma S, Kurosaki A, Motoi N, Yoshimura K. High-Resolution computed tomography findings of lung cancer associated with idiopathic pulmonary fibrosis. J Comput Assist Tomogr. 2006;30:95-99
Keywords
Lung, Idiopathic interstitial pneumonia, Malignant tumor,

No. of Applicants : 38

▶ Correct Answer : 2/38,  5.3%
  • - Maimonides Medical Center, Brooklyn, New York, USA Naomi Twersky
  • - Regional Imaging, Riverina, Australia Rashid Hashmi
▶ Correct Answer as Differential Diagnosis : 1/38,  2.6%
  • - China Medical University Hospital,Taiwan Jun-Jun Yeh
▶ Semi-Correct Answer : 30/38,  78.9%
  • - Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Seoul National University Hospital, Seoul, Korea Young Soon Yoon
  • - Pgimer, Chandigarh, India Ram Prakash Galwa
  • - Norfolk and Norwich University Hospital, Norwich, UK Raj kale
  • - EKH Berlin, Germany Michael Weber
  • - National Taiwan University Hospital, Taiwan Yu-Feng Wei
  • - National Taiwan University Hospital, Taiwan Bang-Bin Chen
  • - Aditya imaging Centre, Sayajigunj, Gujarat, India Vivek Patel
  • - KMC Manipal Hospital, India Nabil Sherif Mahmood
  • - Kashan Shahid Beheshti Hospital, Kashan, Iran Ebrahim Razi
  • - Ewha Womans University Hospital, Korea Min Sun Lee
  • - Pgimer, Chandigarh, India Ashish Gupta
  • - Seoul National University Hospital, Seoul, Korea Sang Youn Kim
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Consultant Radiologist, Vizag, India S Pipavath
  • - Korea University Ansan Hospital, Korea Suk Kyu Yeom
  • - Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier Philippe
  • - Sam Anyang Hospital, Korea Jae Seung Seo
  • - Monaldi Hospital, Naples, Italy Gaetano Rea
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - MYH, Indore, India Sonali Jain
  • - Yonsei University Severance Hospital, Korea Hye-Jeong Lee
  • - Yonsei University Shinchon Severance Hospital, Korea Yong Eun Chung
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Ultracare Coimbatore, India Debabrata Das
  • - Nirman Hitech Diagnostic Center, Mumbai, India Minal Seth
  • - Diskapi Yildirim Beyazit Hospital, Ankara, Turkey Meric Tuzun
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