Saladi Lakshmi, Maddu Sai Mounica, Niazi Masooma, Matela Ajsza
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Care Health System, Bronx, NY 10457, USA.
Department of Medicine, Bronx Care Health System, Bronx, NY 10457, USA.
World J Oncol. 2018 Aug;9(4):110-114. doi: 10.14740/wjon1129w. Epub 2018 Sep 6.
Recent advances in imaging techniques led to an increase in the incidence of synchronous and metachronous primary lung cancers due to early detection. Management of these patients is challenging and prognosis depends on the stage of the tumor at initial diagnosis and histological type. A 68-year-old African American male patient with medical history of hypertension and diabetes mellitus presented to our emergency department with right sided chest pain, worsening dyspnea and dry cough of 2-week duration. He also reported significant weight loss and was a smoker with 25 pack-years smoking history. Chest radiology showed a large right pleural effusion. Subsequent thoracentesis and fluid analysis revealed a lymphocytic exudate. Patient underwent bronchoscopy with findings of an endobronchial lesion in the left lower bronchus. Microscopic analysis of the biopsy specimen showed a well differentiated carcinoid. It was decided to proceed with VATS and pleural biopsy as part of workup for unexplained exudative pleural effusion. Multiple pleural nodules were detected during the procedure and biopsy of these nodules revealed adenocarcinoma of lung. He was evaluated by Oncology and underwent palliative chemotherapy. The association of carcinoid with adenocarcinoma of lung was infrequently reported in the past. This case also highlights the importance of additional diagnostic workup for primary when the diagnosed malignancy does not explain the clinical presentation.
成像技术的最新进展导致由于早期检测，同时性和异时性原发性肺癌的发病率增加。这些患者的管理具有挑战性，预后取决于初始诊断时肿瘤的分期和组织学类型。一名68岁有高血压和糖尿病病史的非裔美国男性患者因右侧胸痛、进行性加重的呼吸困难和持续2周的干咳就诊于我们的急诊科。他还报告有明显体重减轻，是一名有25包年吸烟史的吸烟者。胸部放射学检查显示右侧大量胸腔积液。随后的胸腔穿刺和液体分析显示为淋巴细胞渗出液。患者接受了支气管镜检查，发现左肺下叶支气管内有病变。活检标本的显微镜分析显示为高分化类癌。决定进行电视辅助胸腔镜手术（VATS）和胸膜活检，作为对不明原因渗出性胸腔积液检查的一部分。手术过程中发现多个胸膜结节，这些结节的活检显示为肺腺癌。他接受了肿瘤学评估并接受了姑息化疗。类癌与肺腺癌的关联在过去很少被报道。该病例还强调了当初始诊断的恶性肿瘤无法解释临床表现时，对原发性疾病进行额外诊断检查的重要性。
