RESUMEN
A 74-year-old man was referred to our hospital for examination of an abnormal chest shadow. A chest computed tomography (CT) scan revealed a 5-cm mass attached to the pleura involving the right upper lobe, and a nodule in the right middle lobe. Transbronchial lung biopsy was performed twice, but no definitive diagnosis was achieved. 18-fluorodeoxyglucose positron emission tomography showed abnormal uptake in the chest lesion. Chemotherapy was initiated for advanced-stage lung cancer, but was not effective. Histopathologic and immunohistochemical examinations after CT-guided needle biopsy revealed malignant mesothelioma. The tumor cells were positive for calretinin and thrombomodulin, and negative for CEA, TTF-1, and SP-A. There was local tumor invasion and metastasis in the lung and brain, without diffuse pleural spread. This is a rare and important case of localized malignant mesothelioma pathologically confirmed by biopsy.
Asunto(s)
Neoplasias Pleurales/patología , Tumor Fibroso Solitario Pleural/patología , Anciano , Humanos , MasculinoRESUMEN
An 82-year-old man with fever and a cough was admitted to hospital. A chest radiograph demonstrated infiltrative shadows in the bilateral middle and lower lung fields and a chest CT scan showed the shadows in the bilateral upper and lower lobes. After admission, infiltrative shadows in the right upper lobe increased and transbronchial lung biopsy (TBLB) specimens disclosed organizing exudates in the alveolar spaces. After steroid treatment, the radiographic infiltrates disappeared but the irregular shadows in the right lower lobe were still present. Lung adenocarcinoma was diagnosed by TBLB specimens of residual shadows. Few cases of cryptogenic organizing pneumonia (COP) with lung cancer have been reported, and further consideration should be given to the relationship between COP and lung cancer. We should consider that diagnostic preparations for chest radiographic imaging can lead to the recognition of several respiratory diseases.