Kim Yoonjoo, Yoo Geon, Lee Da-Hye, Lee Choong-Sik, Chung Chaeuk
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
Clinical Research Division, National Institute of Food and Drug Safety Evaluation, Cheongju-si, Republic of Korea.
SAGE Open Med Case Rep. 2021 May 16;9:2050313X211010639. doi: 10.1177/2050313X211010639. eCollection 2021.
Spontaneous regression of lung cancer is exceptionally rare. But there have been several intriguing cases reported in early and even advanced stages of lung cancer. Although the exact mechanism remains to be elucidated, the inflammation and immunologic response have been suggested as one of the means of spontaneous regression. Chronic inflammation is generally known to induce and aggravate tumorigenesis, but the relationship between cancer and inflammation highly depends on the contexts. Here, we present a case of a 60-year-old male ex-smoker who complained of recurrent hemoptysis, cough, and purulent sputum. The initial chest CT scan revealed diffuse bronchial thickening and an endobronchial mass-like lesion in the left lingular segment. The bronchoscopic and pathological findings also suggested a diagnosis of squamous cell carcinoma with severe mucosal inflammation. He was treated with antibiotics for the bronchitis during the first 1 week and his symptoms markedly improved. After 3 weeks, he underwent a follow-up examination. Chest computed tomography and bronchoscopy revealed the significant improvement of the bronchial narrowing and mucosal edema. Biopsy was performed several times around the lesion where the tissue was initially taken. However, the pathological results showed only chronic inflammation of bronchi, not cancer cells. Fortunately, there was no recurrence of lung cancer in follow-up chest computed tomography or bronchoscopy for almost 5 years. In this case, the incidentally diagnosed bronchial squamous cell carcinoma disappeared after severe inflammatory reaction of the bronchial wall. The clinician should remind the risk of early lung cancer accompanied with bronchitis in high-risk patients of lung cancer and also be aware that although it is very rare, the lesions could spontaneously regress.
肺癌的自发消退极为罕见。但在肺癌的早期甚至晚期都有几例引人关注的病例报道。尽管确切机制仍有待阐明,但炎症和免疫反应被认为是自发消退的方式之一。一般认为慢性炎症会诱导和加剧肿瘤发生,但癌症与炎症之间的关系很大程度上取决于具体情况。在此,我们报告一例60岁男性既往吸烟者,他主诉反复咯血、咳嗽和咳脓性痰。最初的胸部CT扫描显示弥漫性支气管增厚以及左舌段支气管内肿块样病变。支气管镜检查和病理结果也提示诊断为鳞状细胞癌伴严重黏膜炎症。在最初的1周内,他接受了针对支气管炎的抗生素治疗,症状明显改善。3周后,他接受了随访检查。胸部计算机断层扫描和支气管镜检查显示支气管狭窄和黏膜水肿有显著改善。在最初取材的病变周围多次进行活检。然而,病理结果仅显示支气管慢性炎症,未见癌细胞。幸运的是,在近5年的随访胸部计算机断层扫描或支气管镜检查中,肺癌未复发。在该病例中,偶然诊断的支气管鳞状细胞癌在支气管壁发生严重炎症反应后消失。临床医生应提醒肺癌高危患者注意伴有支气管炎的早期肺癌风险,同时也要意识到尽管这种情况非常罕见,但病变可能会自发消退。