Tuberc Respir Dis.  2009 May;66(5):390-395. 10.4046/trd.2009.66.5.390.

A Case of Squamous Cell Carcinomatous Lung Abscess with Multiple Metastatic Abscesses

• Lim JE
• Kim EY
• Jang JE
• Son JY
• Jung JY
• Park BH
• Lee KJ
• Yoon YW
• Byun MK
• Lee SR
• Kang YA
• Moon JW
• Park MS
• Kim YS
• Jang J
• Park YN
• Kim SK

• KMID: 1846404
• DOI: http://doi.org/10.4046/trd.2009.66.5.390

Abstract

Among the bronchogenic carcinomas, especially squamous cell carcinoma and large cell carcinoma frequently present with cavitation, which may result from tumor necrosis. Cavitary lesions of the tumor are occasionally associated with infection and misdiagnosed as benign lung abscess owing to the partial responsiveness to antibiotics. It is very difficult to distinguish the carcinomatous abscess from the benign lung abscess, because of their similar clinical and radiologic features. Delay in diagnosis of underlying lung cancer may result in poor outcome. Therefore, clinicians should remember that the patients with highly suspicious carcinoma of the lung should undergo further precise examinations to find out malignant cells.

Keyword

Carcinomatous abscess; Lung abscess; Liver abscess; Squamous cell carcinoma

MeSH Terms

Abscess
Anti-Bacterial Agents
Carcinoma, Bronchogenic
Carcinoma, Large Cell
Carcinoma, Squamous Cell
Humans
Liver Abscess
Lung
Lung Abscess
Lung Neoplasms
Necrosis
Anti-Bacterial Agents

Figure

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  Figure 1 (A) Chest radiography at admission showed a huge mass with buldge out of the major fissure in the right upper lobe. (B) Chest radiography at hospital day 8 showed more enlarged large mass in the right upper lobe. (C) Chest radiography at hospital day 36 showed more enlarged mass in both lung field.

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  Figure 2 Chest CT (at admission of the other hospital) showed a huge large necrotic mass (12 cm) with peripheral hypervascularity in the posterior segment of right upper lobe, another small necrotic nodule in the lingular segment of left upper lobe and necrotic mass in the right lobe of liver.

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  Figure 3 Chest CT at hospital day 8 showed increase in size of huge necrotic mass in the posteriors segment of right upper lobe and nodule in the lingular segment and also showed increase in size of necrotic nodule in the right lobe of liver.

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  Figure 4 PET scan showed a huge necrotic mass with peripheral intense FDG uptake in the right lung and another smaller mass in the left lung. Multiple small nodular increased FDG uptake in the lung. Multiple similar masses In the liver, right adrenal gland, upper pole of left kidney and multiple bones. PET scan aggressively suggested the probability of malignancy with multiple metastasis.

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  Figure 5 (A) The biopsied tissues from the liver showed poorly differentiated carcinoma with marked necrosis, favoring metastasis (H&E stain, ×200). (B) Immunohistochemical staining result. The nuclei of tumor cells are focally expressed by p63 (p63 stain, ×200).

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