Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, No.804 Shenglijie, Xingqing District, Yinchuan, 750004, China.
Ningxia Medical University, Yinchuan, Ningxia, China.
BMC Pulm Med. 2020 Mar 20;20(1):69. doi: 10.1186/s12890-020-1094-1.
Lung cancer is one of the most common co-morbid conditions in patients with idiopathic pulmonary fibrosis (IPF) and negatively affects the prognosis of IPF; Current guidelines for the management of IPF do not give a clear statement on how to manage these patients, and traditional chemotherapy for lung cancer had a limited efficiency rate. Here, we present a rare case of primary lung squamous carcinoma in a patient with IPF whose tumor completely regressed following gemcitabine plus cisplatin therapy; the cancer was no longer detectable after 2 years upon follow-up.
Sixty-seven year-old male patient with IPF was admitted to hospital due to acute onset hemoptysis. In addition to a definite usual interstitial pneumonia (UIP) pattern, a chest CT scan showed a non-enhancing nodular opacity in the right upper lobe and an enhancing nodule in the right lower lobe. Bronchoscopic biopsy of the nodule in the right lower lobe revealed squamous lung cancer. After 2 cycles of chemotherapy with gemcitabine and cisplatin, the tumor in the right lower lobe was no longer detectable after 2 years of follow-up; however, the nodule in the right upper lobe had increased significantly. Finally, Mycobacterium tuberculosis (MTB) was cultured from the bronchoalveolar (BAL) sample submitted at the last evaluation, and the patient was confirmed to have active pulmonary TB.
We report the first documented case of complete pulmonary squamous carcinoma regression in IPF following gemcitabine plus cisplatin. Traditional chemotherapy is considered inadequate to cause the resulting regression of the tumor. The concomitant active pulmonary tuberculosis possibly underlies the mechanism.
肺癌是特发性肺纤维化（IPF）患者最常见的合并症之一，对 IPF 的预后产生负面影响；目前 IPF 管理指南并未明确说明如何管理这些患者，传统的肺癌化疗有效率有限。在这里，我们报告了一例罕见的 IPF 合并原发性肺鳞癌病例，该患者接受吉西他滨加顺铂治疗后肿瘤完全消退；随访 2 年后癌症已无法检测到。
一名 67 岁男性 IPF 患者因急性大咯血住院。除明确的寻常型间质性肺炎（UIP）模式外，胸部 CT 扫描显示右上肺有一个不增强的结节状阴影和右下肺有一个增强结节。右下肺结节的支气管镜活检显示为鳞状肺癌。接受吉西他滨和顺铂 2 个周期化疗后，右下肺肿瘤在 2 年后的随访中已无法检测到；然而，右上肺的结节明显增大。最后，在最后一次评估时提交的支气管肺泡灌洗液（BAL）样本中培养出结核分枝杆菌（MTB），患者被确诊为活动性肺结核。
我们报告了首例 IPF 患者接受吉西他滨加顺铂化疗后完全消退的肺鳞癌。传统化疗不足以导致肿瘤消退。可能是同时发生的活动性肺结核导致了这种结果。
