Tong Jin, Wang Dao-Xin, Zhou Zhi-Yu, Deng Wang
Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, China.
Transl Cancer Res. 2023 Feb 28;12(2):427-433. doi: 10.21037/tcr-22-1853. Epub 2023 Feb 16.
Correct diagnosis of bronchioloalveolar carcinoma (BAC) is often delayed due to the lack of familiarity with the condition among clinicians as its sporadic nature and its symptoms are similar to other respiratory issues. Among these, acute respiratory failure (ARF) caused by massive bronchorrhea is rarely associated with BAC. Here we first reported osimertinib in the treatment of BAC with bronchorrhea and ARF.
A 38-year-old woman presented with massive bronchorrhea and progressive dyspnea. A chest computed tomography (CT) scan showed consolidation with air bronchograms and multiple nodules in both lungs. The patient had no history of chronic pulmonary disease, diabetes mellitus, hypertension or smoke. The patient was initially diagnosed with pneumonia, but ARF developed despite the antibiotic therapy provided. Lung biopsy results revealed nonmucinous BAC. Osimertinib (80 mg daily) was prescribed and proved effective for the first time with an improved ARF and a decreased multiple nodules or consolidation in the lungs during the follow-up period.
It is important for physicians to recognize the typical symptoms and radiological manifestations of BAC to avoid misdiagnosis or late diagnosis. This is especially important since early diagnosis allows for immediate epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy, which is a potentially beneficial treatment for patients with BAC.
由于临床医生对细支气管肺泡癌（BAC）缺乏了解，加上其散发性本质以及症状与其他呼吸系统疾病相似，BAC的正确诊断常常延迟。其中，大量支气管分泌液引起的急性呼吸衰竭（ARF）很少与BAC相关。在此，我们首次报道了奥希替尼治疗伴有支气管分泌液和ARF的BAC。
一名38岁女性出现大量支气管分泌液和进行性呼吸困难。胸部计算机断层扫描（CT）显示两肺实变伴空气支气管征和多个结节。该患者无慢性肺病、糖尿病、高血压病史，也不吸烟。患者最初被诊断为肺炎，但尽管给予了抗生素治疗，仍出现了ARF。肺活检结果显示为非黏液性BAC。给予奥希替尼（每日80毫克），首次证明有效，随访期间ARF改善，肺部多个结节或实变减少。
医生认识BAC的典型症状和影像学表现以避免误诊或延迟诊断很重要。这一点尤为重要，因为早期诊断可使患者立即接受表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗，这对BAC患者是一种潜在的有益治疗方法。
