A Case of Severe Hypoxic Respiratory Failure Caused by an Unusual Presentation of Primary Bronchogenic Adenocarcinoma

Abstract SESSION TYPE: Cancer Case Report Posters IPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: We report a case of hypoxic respiratory failure caused by pneumonic type primary bronchogenic adenocarcinoma with extensive metastasis to contralateral lung in the absence of extra-pulmonary metastasis.CASE PRESENTATION: A 53 year old Hispanic man with no significant past medical history was admitted with progressive dyspnea on exertion of 5 weeks duration. This was associated with a significant weight loss, productive clear cough and low grade fever. His symptoms shortly started after a trip to Mexico. On examination he had decrease breath sounds in the left side. Chest Radiography (CXR) was positive for consolidation on the left upper lobe with multiple bilateral small pulmonary nodular opacities, Computerized tomography (CT) scan of the chest identified Innumerable randomly distributed pulmonary nodules in both lungs and dense airspace consolidation within the left upper lobe. Bronchoalveolar lavage ruled out Tuberculosis and other infections but was positive for atypical cells. Left upper lobe trans-bronchial lung biopsies were positive for invasive poorly differentiated adenocarcinoma with tumor cells completely occupying and obliterating the alveolar spaces. Staging work up did not show any other organ involvement. The patient was referred for oncology however shortly after that he progressed to hypoxic respiratory failure and died 4 weeks after the diagnosis.DISCUSSION: This case has an uncommon presentation with a consolidation however the unique findings is that of widespread and likely aerogenic metastatic bronchogenic adenocarcinoma to both lungs causing respiratory failure with no extra-pulmonary metastasis. Tumor presentation as an airspace consolidative lesion is a atypical but well-recognized pattern of adenocarinoma formaly named "bronchiolo-alveolar carcinoma". In this unique case the tumor had metastasized extensively to both lungs with no extra pulmonary metastasis in autopsy supporting the argument for possible aerogenic metastasisCONCLUSIONS: Physicians should be aware of atypical presentation of tumors and consider adencarnioma in the differential of non-resolving consolidation even in the absence of mass lesion. Our case may possibly represent an aerogenic spread of tumor cells to the ipsilateral and contralateral lungs.1) William D. Travis, 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: Executive Summary Proc Am Thorac Soc 2011; 8: 381-385.2) Gandara DR, Aberle D, Lau D, et al. Radiographic imaging of bronchioloalveolar carcinoma: screening, patterns of presentation and response assessment. J Thorac Oncol. 2006 Nov;1(9 Suppl):S20-6.DISCLOSURE: The following authors have nothing to disclose: Bashar Farjo, Anandhi Murugan, Weissferdt AnnikkaNo Product/Research Disclosure InformationUniversity of Texas, Health Science Center, Houston, TX.