Unusual presentation of lepidic adenocarcinoma in a healthy female
Abstract Background Lepidic adenocarcinoma represents a histologic pattern of non-small cell lung cancer that characteristically arises in the lung periphery with tracking alongside pre-existing alveolar walls. Noninvasive and invasive variants of lepidic adenocarcinoma are dependent on parenchymal...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-022-01969-1 |
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| author | Zaheer Akhtar Leah Laageide Julian Robles Christopher Winters Geoffrey C. Wall James Mallen Zeeshan Jawa |
| author_facet | Zaheer Akhtar Leah Laageide Julian Robles Christopher Winters Geoffrey C. Wall James Mallen Zeeshan Jawa |
| author_sort | Zaheer Akhtar |
| collection | DOAJ |
| description | Abstract Background Lepidic adenocarcinoma represents a histologic pattern of non-small cell lung cancer that characteristically arises in the lung periphery with tracking alongside pre-existing alveolar walls. Noninvasive and invasive variants of lepidic adenocarcinoma are dependent on parenchymal destruction, vascular, or pleural invasion. The lepidic-predominant lung malignancies are collectively recognized as slow growing with rare metastasis and excellent prognosis. The World Health Organization classification of lung malignancies depends on molecular and histopathological findings. CT findings most commonly include ground-glass characteristics, commonly mistaken for inflammatory or infectious etiology. These tumors are generally surgically resectable and associated with better survival given infrequent nodal and extrathoracic involvement. Rarely these tumors present with diffuse pneumonic-type involvement associated with worse outcomes despite lack of nodal and distant metastases. Case presentation A 63-year-old Caucasian athletic immunocompetent female presented with 2 months of progressive shortness of breath, fatigue, loss of appetite and 15 pound weight loss. History was only notable for well controlled essential hypertension and hypothyroidism. Contrast computed tomography angiogram and positron emission tomography revealed diffuse hypermetabolic interstitial and airspace abnormalities of the lungs without lymphadenopathy (or distant involvement) in addition to right hydropneumothorax and left pleural effusion. Baseline laboratory testing was unremarkable, and extensive bacterial and fungal testing returned negative. Bronchoscopy and video-assisted thoracoscopic surgery was subsequently performed with pleural fluid cytology, lung and pleural biopsies returning positive for lepidic adenocarcinoma with 2% programmed death ligand 1 expression and genomic testing positive for PTEN gene deletion. Prior to treatment, the patient perished on day 15 of admission. Conclusion We present a rare case of lepidic predominant adenocarcinoma with extensive bilateral aerogenous spread in the context of no lymphovascular invasion in a healthy, low risk patient. This case presentation may add to the body of knowledge regarding the different behavior patterns of lepidic predominant adenocarcinomas. |
| first_indexed | 2024-04-12T17:18:14Z |
| format | Article |
| id | doaj.art-d62e726df25a4a9abc06ceb03f10f0ef |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-12T17:18:14Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-d62e726df25a4a9abc06ceb03f10f0ef2022-12-22T03:23:35ZengBMCBMC Pulmonary Medicine1471-24662022-05-012211810.1186/s12890-022-01969-1Unusual presentation of lepidic adenocarcinoma in a healthy femaleZaheer Akhtar0Leah Laageide1Julian Robles2Christopher Winters3Geoffrey C. Wall4James Mallen5Zeeshan Jawa6PGY3 Internal Medicine Resident, Department of Medical Education, UnityPoint HealthDepartment of Medicine, UnityPoint HealthDepartment of Medicine, UnityPoint HealthDepartment of Surgery, UnityPoint HealthDrake College of Pharmacy and Health SciencesDepartment of Pulmonology, The Iowa Clinic and UnityPoint HealthJohn Stoddard and Mission Cancer CenterAbstract Background Lepidic adenocarcinoma represents a histologic pattern of non-small cell lung cancer that characteristically arises in the lung periphery with tracking alongside pre-existing alveolar walls. Noninvasive and invasive variants of lepidic adenocarcinoma are dependent on parenchymal destruction, vascular, or pleural invasion. The lepidic-predominant lung malignancies are collectively recognized as slow growing with rare metastasis and excellent prognosis. The World Health Organization classification of lung malignancies depends on molecular and histopathological findings. CT findings most commonly include ground-glass characteristics, commonly mistaken for inflammatory or infectious etiology. These tumors are generally surgically resectable and associated with better survival given infrequent nodal and extrathoracic involvement. Rarely these tumors present with diffuse pneumonic-type involvement associated with worse outcomes despite lack of nodal and distant metastases. Case presentation A 63-year-old Caucasian athletic immunocompetent female presented with 2 months of progressive shortness of breath, fatigue, loss of appetite and 15 pound weight loss. History was only notable for well controlled essential hypertension and hypothyroidism. Contrast computed tomography angiogram and positron emission tomography revealed diffuse hypermetabolic interstitial and airspace abnormalities of the lungs without lymphadenopathy (or distant involvement) in addition to right hydropneumothorax and left pleural effusion. Baseline laboratory testing was unremarkable, and extensive bacterial and fungal testing returned negative. Bronchoscopy and video-assisted thoracoscopic surgery was subsequently performed with pleural fluid cytology, lung and pleural biopsies returning positive for lepidic adenocarcinoma with 2% programmed death ligand 1 expression and genomic testing positive for PTEN gene deletion. Prior to treatment, the patient perished on day 15 of admission. Conclusion We present a rare case of lepidic predominant adenocarcinoma with extensive bilateral aerogenous spread in the context of no lymphovascular invasion in a healthy, low risk patient. This case presentation may add to the body of knowledge regarding the different behavior patterns of lepidic predominant adenocarcinomas.https://doi.org/10.1186/s12890-022-01969-1Non small cell lung cancerAdenocarcinomaLepidic patternBronchioloalveolar carcinomaMicronodular infiltratesCase report |
| spellingShingle | Zaheer Akhtar Leah Laageide Julian Robles Christopher Winters Geoffrey C. Wall James Mallen Zeeshan Jawa Unusual presentation of lepidic adenocarcinoma in a healthy female BMC Pulmonary Medicine Non small cell lung cancer Adenocarcinoma Lepidic pattern Bronchioloalveolar carcinoma Micronodular infiltrates Case report |
| title | Unusual presentation of lepidic adenocarcinoma in a healthy female |
| title_full | Unusual presentation of lepidic adenocarcinoma in a healthy female |
| title_fullStr | Unusual presentation of lepidic adenocarcinoma in a healthy female |
| title_full_unstemmed | Unusual presentation of lepidic adenocarcinoma in a healthy female |
| title_short | Unusual presentation of lepidic adenocarcinoma in a healthy female |
| title_sort | unusual presentation of lepidic adenocarcinoma in a healthy female |
| topic | Non small cell lung cancer Adenocarcinoma Lepidic pattern Bronchioloalveolar carcinoma Micronodular infiltrates Case report |
| url | https://doi.org/10.1186/s12890-022-01969-1 |
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