대한흉부영상의학회 Weekly Chest Cases

Case No : 500 Date 2007-05-28

Courtesy of Eun-Young Kang, MD, Ok Hee Woo, MD, Hwan-Seok Yong, MD. / Korea University Guro Hospital, Seoul, Korea
Age/Sex 56 / F
Chief ComplaintDyspnea and cough for 1 month

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Diagnosis With Brief Discussion

Diagnosis: NSIP associated with primary lung cancer
Radiologic Findings: Chest radiograph (Fig. 1) shows poorly defined opacities in both lower lung zone and a 2.5 cm nodule in right upper lobe. Chest CT scan (Fig. 2-5) shows ground-glass opacities and consolidation distributed in peripheral lungs and along the bronchovascular bundle in both lower lungs. A 2.5 cm sized, round, enhancing nodule is also noted in RUL with ipsilateral mediastinal lymph node enlargements.
Transthoracic needle aspiration biopsy was performed on RUL nodule. PTNA specimen showed adenocarcinoma, moderate differentiated (Fig. 6). And VATS biopsy was done in two sites of RLL. VATS biopsy specimen showed nonspecific interstitial pneumonia, fibrosing group (Fig 7).
NSIP was responded to steroid therapy, but the patient died from lung cancer.
Brief Review: Lung cancer is frequently associated with UIP and UIP may be a precancerous lesion. However, NSIP associated with primary lung cancer has been rarely reported. There are a few reports about association between NSIP and primary lung cancer. Sato T. et al. suggested that NSIP probably reflects the local immune response to an antigenic stimulus caused by lung cancer and this combination is considered to be one of the paraneoplastic phenomena.
Bronchogenic carcinoma has frequently been associated with paraneoplastic phenomenon, ranging from mild systemic or cutaneous disease to neuromyopathic disorders and interstitial pneumonia. Proposed mechanisms of paraneoplastic processes include the aberrant release of humoral mediators such as hormones and hormone-like peptides, cytokines, and antibodies.
References: 1. Sato T, Yamadori I, Fujita J, et al. Three cases of non-specific interstitial pneumonia associated with primary lung cancer. Intern Med. 2004;43(8):721-726.
2. Yamadori I, Sato T, Fujita J, Dobashi N, Ohtsuki Y, Takahara J. A case of non-specific interstitial pneumonia associated with primary lung cancer: possible role of antibodies to lung cancer cells in the pathogenesis of non-specific interstitial pneumonia. Respir Med. 1999;93(10):754-756.
3. Patel AM, Davila DG, Peters SG. Paraneoplastic syndromes associated with lung cancer. Mayo Clin Proc. 1993;68(3):278-287.
Keywords: lung, Interstitium, Malignant tumor, NSIP,

No. of Applicants : 38

▶ Correct Answer : 14/38, 36.8%

- Depart of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Nirman Hitech centre, Malald, Apollo Clinic, Kandivali, Mumbai, India Jeshil R. Shah
- Trupti dabholkar
- Osaka University, Japan Osamu Honda
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Changi General Hospital, Singapore Angeline Poh
- Ondokuz Mayis University, Samsun Turkey Cetin Celenk
- IRSA La Rochelle, France Jean-Luc BIGOT
- Hospital Sotiria, Athens, Greece Vasilios Tzilas
- ANNEMASSE, Polyclinique de SAVOIE, France Gay-Depassier Philippe
- Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
- Doctors Hospital, Nassau, Bahamas N.B.S. Mani
- Pittwater Radiology, Australia Saurabh Khandelwal
- Australia Julie Arora

▶ Correct Answer as Differential Diagnosis : 1/38, 2.6%

- Asan Medical Center, Korea Eun Jin Chae

▶ Semi-Correct Answer : 18/38, 47.4%

- Registrar in Radiology, UHL NHS Trust, UK A. Donuru
- Ruby Hall Clinic, Pune, India John Joseph
- Ruby Hall Clinic, Pune, India Nikhil Unune
- Regional Imaging Riverina, Australia Rashid Hashmi
- Hospital Sao Paulo, Brazil Israel Missrie
- Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
- National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
- Nour El-Islam Radiology Center, Alexandria, Egypt, Elsayed Mohamed Mousa
- China Medical University Hospital, Taiwan Jun-Jun Yeh
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Annecy hospital, France Gilles Genin
- Armed Forces ChunCheon Hospital (AFCC), Korea Chae Hun Lim
- Homs National Hospital, Homs - Syria Rami Abou Zalaf
- IRSA, La Rochelle, France Denis Chabassiere
- EKH-Berlin, Germany Michael Weber
- KAUMS, Kashan, Iran Ebrahim Razi
- Aims, New Delhi, India Ashish Gupta
- CHU Grenoble, France Bing Fabrice

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 500 Date 2007-05-28

Discussion

No. of Applicants : 38