대한흉부영상의학회 Weekly Chest Cases

Case No : 229 Date 2002-03-16

Courtesy of Chin A Yi, M.D. Tae Sung Kim, M.D., Kyung Soo Lee, / Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Age/Sex 23 / F
Chief ComplaintWeight loss / blood tinged sputum / cough / sputum for several months

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Diagnosis With Brief Discussion

Diagnosis: Cavitary Adenocarcinoma
Radiologic Findings: On chest radiograph, patchy areas of consolidation and reticulonodular opacity are seen in right upper lobe. Right paratracheal stripe is thickened, representing right paratracheal lymphadenopathy. Considering that she is 23 year-old nonsmoker and her place of residence is endemic area of pulmonary tuberculosis, the radiologic diagnosis was active pulmonary TB. In spite of antituberculous medication for 3 months, her symptom and radiographic abnormality have been progressed and no tuberculous organism is isolated on her sputum examination.
On CT scan, a large multiseptated cavitary lesion is noted in right upper lobe without definite evidence of communication with airway. Also seen is associated consolidation around the cavitary lesion. These findings suggest the possibility of cavitary mass, including semi-invasive aspergillosis and cavitary lung cancer. Still the possibility of pulmonary Tb is considered.
Percutaneous needle aspiration was done for lesion in right upper lobe, and pathologic diagnosis is adenocarcinoma with non-mucinous "BAC" pattern. She underwent neoadjuvant chemoradiation therapy due to lymph node metastasis. Finally right upper and middle lobectomy was done, revealing the 6x4cm adenocarcinoma with 30% of cavitary area, 20% of necrosis and 20% of fibrosis.
Brief Review: The presence of intratumoral radiolucencies is known as an important feature of bronchioloalveolar carcinoma and squamous cell carcinoma of the lung. Primary pulmonary adenocarcinoma rarely shows cavitation on chest CT. Herein we describe such a case misdiagnosed as pulmonary tuberculosis.
Cavitation was found in 27 cases (11%) of 220 primary lung cancers and 24 metastatic lung cancers. Every cavitated tumor but one was a primary lung neoplasm. Twenty-one (81%) of these 26 cavitated primary lung tumors were squamous cell carcinoma. Large cell undifferentiated carcinoma (two cases of 7%), adenocarcinoma (one case or 4%), small cell undifferentiated carcinoma (one case or 4%) and alveolar cell carcinoma (one case or 4%) made up the rest (1).
Two case reports were published in Japan for cavitating adenocarcinoma of the lung (2, 3).
References: 1. Chiu FT. Cavitation in lung cancers. Aust N Z J Med 1975 Dec;5(6):523-30
2. Takashima S. Cavitating malignant neoplasms in the lung. Rinsho Hoshasen 1989 Jan;34(1):45-50
3. Matsuba T. A case of adenocarcinoma presenting as a cavitary lesion with niveau formation. Nihon Kyobu Shikkan Gakkai Zasshi 1993 Jun;31(6):780-4
Keywords: Lung, Malignant tumor,

No. of Applicants : 19

▶ Correct Answer : 7/19, 36.8%

- Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
- CHU Nancy-Brabois, France Denis Regent
- Harasanshin hospital, Fukuoka, Japan Shunya Sunami
- Korea Cancer Center Hospital, Korea Donghee Park
- Kyunghee University Hospital, Korea Kyung Lan Ko
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
- Sungji Hospital, Korea Jung Hee Kim

▶ Semi-Correct Answer : 12/19, 63.2%

- Bharat Scans, Chennai, India R G Gopinath
- Dong-eui Medical Center, Korea Ha Jong Lee
- Ewha Womans' University, Mokdong Hospital, Korea Kyung Soo Cho
- FJ Gomez de Terreros, Madrid, Spain Carola Y Javier
- Gochang Hospital, Korea Jiyong Rhee
- Gospel Hospital Kosin University, Korea Kyung Hwa Jung
- Inha University Hospital, Korea Dong-Jae Shim
- Masan Yeonse Hospital, Korea Sang Hee Lee
- Ospedale di Jesi, Italy Giancarlo Passarini
- Pulmonologist, Korea Jae-Joon Yim
- Sctimst, Trivandrum, India Vilvendhan Rajendran
- Wallaece Memorial Baptist Hospital, Korea Mi ok Sunwoo

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 229 Date 2002-03-16

Discussion

No. of Applicants : 19