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VOLUME 66 , ISSUE 1 ( January-March, 2024 ) > List of Articles


Atypical Presentation of Lepidic Adenocarcinoma Lung in a Healthy Female: A Case Report

Sapna Yadav, Mithilesh Chandra

Keywords : Adenocarcinoma lung, Bronchoscopy, Case report, Cytokeratin 7, Lepidic, Lung, Lung cancer, Miliary nodules, Napsin A

Citation Information : Yadav S, Chandra M. Atypical Presentation of Lepidic Adenocarcinoma Lung in a Healthy Female: A Case Report. Indian J Chest Dis Allied Sci 2024; 66 (1):20-22.

DOI: 10.5005/jp-journals-11007-0106

License: CC BY-NC 4.0

Published Online: 03-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim: To report unusual clinical and radiological presentation of adenocarcinoma in a healthy female. Background: Adenocarcinoma is the most common subtype in nonsmokers. The radiological presentation may range from solitary nodules to large masses and multilobar consolidations. In the present case, radiological presentation mimicked miliary tuberculosis but it turned out to be lepidic adenocarcinoma on further evaluation. Lepidic adenocarcinoma is characterized by the proliferation of tumor cells along the lines of alveolar walls with or without evidence of stromal, vascular, and pleural invasion. Case description: A 60-year-old female patient with no known comorbidities presented to the outpatient department with nonspecific complaints of mild chest and abdominal discomfort and uneasiness. Chest X-ray showed diffuse multiple numerous randomly distributed sharply marginated nodules in bilateral lung parenchyma suggesting the possibility of miliary nodules, and small air space consolidation in both upper lobes. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy was performed. Investigations for Tuberculosis, Fungal, and Bacterial infections were negative. Transbronchial lung biopsy histopathology and immunohistochemistry (IHC) [Napsin A and cytokeratin 7 (CK-7)] revealed features suggestive of primary minimally invasive adenocarcinoma lung – lepidic type. The patient was referred to the medical oncology department. Conclusion: Adenocarcinoma lung is the most common subtype of non-small lung cancer. Clinical and radiological presentation can mimic other infective or nonmalignant diseases. A high index of suspicion and further evaluation is required in concerned patients to identify it at the earliest.

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  1. Bray F, Colombet M, Mery L, et al. Cancer Incidence in Five Continents – Vol. XI. Lyon, France: IARC Scientific Publications; 2017.
  2. Khuder SA. Effect of cigarette smoking on major histological types of lung cancer: A meta-analysis. Lung Cancer 2001;31:139–148. DOI: 10.1016/s0169-5002(00)00181-1.
  3. Travis WD, Brambilla E, Muller–Hermelink HK, et al. Tumours of the lung. In: Travis WD, Brambilla E, Muller Hermelink HK, et al., editors. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. WHO Classification of Tumours. Vol. 10. Lyon, France: IARC Press; 2004.
  4. Travis WD, Brambilla E, Nicholsan AG, et al. The 2015 World Health Organization classification of ling tumors. J Thoraconcol 2015;10(9):1243–1260. DOI: 10.1097/JTO.0000000000000630.
  5. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma. J Thorac Oncol 2011;6(2):244–285. DOI: 10.1097/JTO.0b013e318206a221.
  6. Devesa SS, Shaw GL, Blot WJ. Changing patterns of lung cancer incidence by histological type. Cancer Epidemiol Biomarkers Prev 1991;1:29–34. PMID: 1845165.
  7. Stellman SD, Muscat JE, Thompson S, et al. Risk of squamous cell carcinoma and ademocarcinoma of the lung in relation to lifetime filter cigarette smoking. Cancer 1997;80(3):382–388. DOI: 10.1002/(sici)1097-0142(19970801)80:3<382::aid-cncr5>;2-u.
  8. Pascoe HM, Knipe HC, Pascoe D, et al. The many faces of lung adenocarcinoma: A pictorial assay. J Med Imaging Radiat Oncol 2018;62(5):654–661. DOI: 10.1111/1754-9485.12779.
  9. Tang Y, He Z, Zhu Q, et al. The 2011 IASLC/ATS/ERS pulmonary adenocarcinoma classification: A landmark in personalized medicine for lung cancer management. J Thorac Dis 2014;6(Suppl. 5): S589–S596. DOI: 10.3978/j.issn.2072-1439.2014.09.15.
  10. Lee KS, Kim Y, Han J, et al. Bronchioalveolar carcinoma: Clinical, histopathological, and radiological findings. Radiographics 1997;17(6):1345–1357. DOI: 10.1148/radiographics.17.6.9397450.
  11. Shrager JB, Approach to the patient with multiple lung nodules. Thorac Surg Clin 2013;23(2):257–266. DOI: 10.1016/j.thorsurg.2013. 01.004.
  12. Detterbeck FC, Homer RJ. Approach to the ground glass nodule. Clin Chest Med 2011;32(4):799–810. DOI: 10.1016/j.ccm.2011. 08.002.
  13. Wrath A, Stenzinger A, von Brünneck AC, et al. Interobserver variability in the application of the novel IASLC/ATS/ERS classification for pulmonary adenocarcinomas. Eur Respire J 2012;40(5):1221–1227. DOI: 10.1183/09031936.00219211.
  14. Yuan M, Liu JY, Zhang T, et al. Prognostic impact of the findings on thin section computed tomography in stage 1 lung adenocarcinoma with visceral pleural invasion. Sci Rep 2018;8(1):4743. DOI: 10.1038/s41598-018-22853-1.
  15. Lakha S, Gomez JE, Flores RM, et al. Prognostic significance of visceral pleural involvement in early-stage lung cancer. Chest 2014;146(6):1619–1626. DOI: 10.1378/chest.14-0204.
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