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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2018, Vol. 12 Issue (3) : 330-333    https://doi.org/10.1007/s11684-017-0545-4
CASE REPORT |
Invasive mucinous adenocarcinoma with lepidic-predominant pattern coexisted with tuberculosis: a case report
Xinxin Xu1, Yinshi Guo2, Qiuying Li3, Ling Yang1(), Jianqiang Kang1
1. Department of Geriatrics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
2. Allergy Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
3. Department of Interventional Radiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
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Abstract

We observed a rare case of invasive mucinous adenocarcinoma (IMA) with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml (reference value of negative is<14 pg/ml), Mycobacterium tuberculosis culture was positive, and tuberculin skin test (PPD) was negative (skin induration<5 mm). The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic-predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.

Keywords invasive mucinous adenocarcinoma      lepidic-predominant      tuberculosis     
Corresponding Authors: Ling Yang   
Just Accepted Date: 19 June 2017   Online First Date: 10 July 2017    Issue Date: 04 May 2018
 Cite this article:   
Xinxin Xu,Yinshi Guo,Qiuying Li, et al. Invasive mucinous adenocarcinoma with lepidic-predominant pattern coexisted with tuberculosis: a case report[J]. Front. Med., 2018, 12(3): 330-333.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0545-4
http://academic.hep.com.cn/fmd/EN/Y2018/V12/I3/330
Fig.1  Chest CT scan results at different time points. (A) Initial chest CT upon admission. Bilateral consolidation combined with multiple fibrosis lesions (yellow arrows), cavitation (blue arrow) in the lower right lobe, and small nodules (red arrows) in the lower left lobe. (B) Chest CT scan image following a month of antibiotic treatments. Atelectasis (yellow arrow) and small cavitation (blue arrow) in the lower right lobe are observable, as well as multiple nodules in the left lobe (red arrow). (C) Chest CT scan following anti-fungal therapy. Multiple solid spiculate nodules (yellow arrow) and cavitations (red arrows) combined with septum distortion (blue arrow). (D) Chest CT scan two weeks after anti-tuberculosis treatment. Diffuse lesions in bilateral lungs, several part-solid nodules can be observed in the left lower lobe (red arrows). Diffuse opaque lesions with low density along the alveolar walls in the lower right lobe (yellow arrows) can be observed. (E) Chest CT scan after experimental therapy. Bilateral pulmonary foci combined with consolidation and nodules (red arrow), bronchiectasis in the right lung, opaque lesions become bigger and diffuse in the whole right lung (yellow arrow), lymph nodes in the mediastinum (not shown in the image), demonstrating a sign of tumor invasion and metastasis.
Fig.2  PET-CT shows nodules in the left lobe are non FDG avid.
Fig.3  A microscopic section of the percutaneous lung biopsy which is an H&E section with 20× magnification demonstrating adenoma cells with pure lepidic growth. The tumor consists of columnar cells abundant with mucin in the apical cytoplasm.
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