Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma
Patients under consideration for lung transplantation as treatment for end-stage lung diseases such as idiopathic pulmonary fibrosis (IPF) often have risk factors such as a history of smoking or concomitant emphysema, both of which can predispose the patient to lung cancer. In fact, IPF itself incre...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018-01-01
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| Series: | Respiratory Medicine Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213007118301588 |
| _version_ | 1811277177200574464 |
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| author | Pradnya D. Patil Samir Sultan M. Frances Hahn Sreeja Biswas Roy Mitchell D. Ross Hesham Abdelrazek Ross M. Bremner Nitika Thawani Rajat Walia Tanmay S. Panchabhai |
| author_facet | Pradnya D. Patil Samir Sultan M. Frances Hahn Sreeja Biswas Roy Mitchell D. Ross Hesham Abdelrazek Ross M. Bremner Nitika Thawani Rajat Walia Tanmay S. Panchabhai |
| author_sort | Pradnya D. Patil |
| collection | DOAJ |
| description | Patients under consideration for lung transplantation as treatment for end-stage lung diseases such as idiopathic pulmonary fibrosis (IPF) often have risk factors such as a history of smoking or concomitant emphysema, both of which can predispose the patient to lung cancer. In fact, IPF itself increases the risk of lung cancer development by 6.8% to 20%. Solid organ malignancy (non-skin) is an established contraindication for lung transplantation. We encountered a clinical dilemma in a patient who presented with an IPF flare-up and underwent urgent evaluation for lung transplantation. After transplant, the patient's explanted lungs showed extensive adenocarcinoma in situ, with the foci of invasion and metastatic adenocarcinoma in N1-level lymph nodes, as well as usual interstitial pneumonia. Retrospectively, we saw no evidence to suggest malignancy in addition to the IPF flare-up. Clinical diagnostic dilemmas such as this emphasize the need for new noninvasive testing that would facilitate malignancy diagnosis in patients too sick to undergo invasive tissue biopsy for diagnosis. Careful pathological examination of explanted lungs in patients with IPF is critical, as it can majorly influence immunosuppressive regimens, surveillance imaging, and overall prognosis after lung transplant. Keywords: Adenocarcinoma in situ, Lung transplant, Lung allocation score, Incidental tumors in lung explants, Lung explant pathology, Lung cancer in lung transplant recipients |
| first_indexed | 2024-04-13T00:11:05Z |
| format | Article |
| id | doaj.art-1b621b9bcef941b8ace0aa97517b95cc |
| institution | Directory Open Access Journal |
| issn | 2213-0071 |
| language | English |
| last_indexed | 2024-04-13T00:11:05Z |
| publishDate | 2018-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Respiratory Medicine Case Reports |
| spelling | doaj.art-1b621b9bcef941b8ace0aa97517b95cc2022-12-22T03:11:05ZengElsevierRespiratory Medicine Case Reports2213-00712018-01-01254548Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemmaPradnya D. Patil0Samir Sultan1M. Frances Hahn2Sreeja Biswas Roy3Mitchell D. Ross4Hesham Abdelrazek5Ross M. Bremner6Nitika Thawani7Rajat Walia8Tanmay S. Panchabhai9Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USADepartment of Pulmonary and Critical Care Medicine, University of Arizona College of Medicine, Banner University Medical Center, Phoenix, AZ, USADepartment of Pathology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USANorton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USANorton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USANorton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USANorton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USADepartment of Radiation Oncology, University of Arizona Cancer Center at St. Joseph's Hospital and Medical Center, Phoenix, AZ, USANorton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USANorton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA; Corresponding author. Department of Pulmonology, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Rd., Suite 500, Phoenix, AZ 85013, USA.Patients under consideration for lung transplantation as treatment for end-stage lung diseases such as idiopathic pulmonary fibrosis (IPF) often have risk factors such as a history of smoking or concomitant emphysema, both of which can predispose the patient to lung cancer. In fact, IPF itself increases the risk of lung cancer development by 6.8% to 20%. Solid organ malignancy (non-skin) is an established contraindication for lung transplantation. We encountered a clinical dilemma in a patient who presented with an IPF flare-up and underwent urgent evaluation for lung transplantation. After transplant, the patient's explanted lungs showed extensive adenocarcinoma in situ, with the foci of invasion and metastatic adenocarcinoma in N1-level lymph nodes, as well as usual interstitial pneumonia. Retrospectively, we saw no evidence to suggest malignancy in addition to the IPF flare-up. Clinical diagnostic dilemmas such as this emphasize the need for new noninvasive testing that would facilitate malignancy diagnosis in patients too sick to undergo invasive tissue biopsy for diagnosis. Careful pathological examination of explanted lungs in patients with IPF is critical, as it can majorly influence immunosuppressive regimens, surveillance imaging, and overall prognosis after lung transplant. Keywords: Adenocarcinoma in situ, Lung transplant, Lung allocation score, Incidental tumors in lung explants, Lung explant pathology, Lung cancer in lung transplant recipientshttp://www.sciencedirect.com/science/article/pii/S2213007118301588 |
| spellingShingle | Pradnya D. Patil Samir Sultan M. Frances Hahn Sreeja Biswas Roy Mitchell D. Ross Hesham Abdelrazek Ross M. Bremner Nitika Thawani Rajat Walia Tanmay S. Panchabhai Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma Respiratory Medicine Case Reports |
| title | Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma |
| title_full | Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma |
| title_fullStr | Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma |
| title_full_unstemmed | Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma |
| title_short | Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma |
| title_sort | incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare up a clinical dilemma |
| url | http://www.sciencedirect.com/science/article/pii/S2213007118301588 |
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