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Weekly Chest CasesArchive of Old Cases

Case No : 45 Date 1998-09-07

  • Courtesy of Yang Soo Kim, M.D. / Chung Ang University Yongsan Hospital
  • Age/Sex 59 / M
  • Chief Complaintcough, sputum, and intermittent hemoptysis for 3 years and mild exertional dyspnea for 3 months
  • Figure 1
  • Figure 2
  • Figure 3

Chest PA

Diagnosis With Brief Discussion

Diagnosis
Lung cancer (adenocarcinoma) associated with Idiopathic Pulmonary fibrosis
Radiologic Findings
Chest radiograph shows an ill-defined infiltration (arrow) in the right upper lobe and reticular densities in the both basal lungs. HRCT scans show honeycombing in periphery of the both lung and a focal infiltration with spiculated margin and traction bronchiectasis, suggesting fibrotic mass in the right upper lobe anterior segment. Honeycomb cysts are also noted in the peripheral portions of the both lower lobes.
Brief Review
It is well recognized that idiopathic pulmonary fibrosis (IPF) is associated with lung cancer at a relatively high rate (about 14 times) compared with that of the general population without fibrosis. Lung cancer in IPF develops mostly in the peripheral portion and the lower lobe, where advanced fibrosis predominates. Squamous cell carcinoma and small cell carcinoma, which occurs mainly in the large bronchi, are frequently found in the peripheral region of the lung in the patient with IPF. However, this fact is not surprising, because squamous epithelial metaplasia and proliferation can also occur in the terminal airways. As to the peripheral origin, lung cancer with IPF is somewhat different from the so-called scar carcinoma of the lung. Namely, scar carcinoma occurs predominantly in the upper lobes and a relatively large population of this type is adenocarcinoma.
Chest radiographic findings of lung cancer associated with IPF are nodular, linear densities, or a honeycomb pattern. Typical CT patterns of lung cancer are ill-defined lesions mimicking air-space consolidation at the peripheral portion where the most advanced fibrosis occurs.
References
1. Mizushima Y, Kobayashi M. Clinical Characteristics of synchronous multiple lung cancer associated with idiopathic pulmonary fibrosis. Chest 1995;108:1272-1277
2. Lee HJ, Im JG, Ahn JM, Yeon KM. Lung cancer in patients with idiopathic pulmonary fibrosis: CT findings. JCAT 1996;20:979-982
3. Fraser RG, Pare JAP, Pare PD, Fraser RS, Generux GP. Diagnosis of diseases of the chest. 3rd ed. Philadelphia: Saunders, 1989:1338-1339
4. Turner-Warwick M, Lebowitz M, Burrows B, et al. Cryptogenic fibrosing alveolitis and lung cancer. Cancer 1989;35:496-499
5. Fraire AE, Greenberg SD. Carcinoma and diffuse interstitial fibrosis of lung. Cancer 1973;21:1078-1086
Keywords
Lung, Malignant tumor, UIP, Lung cancer (adenocarcinoma) associated with Idiopathic Pulmonary fibrosis

No. of Applicants : 31

▶ Correct Answer : 24/31,  77.4%
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▶ Semi-Correct Answer : 3/31,  9.7%
  • - Northwestern University, Evanston, IL. USA Mitchell J. Kline
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