Tuberc Respir Dis.  2008 Aug;65(2):147-151.

Consolidative Bronchioloalveolar Carcinoma Presenting as Pneumonia, and This Led to a Late Diagnosis due to the Improvement after Antibiotic Therapy

• Jeong I
• Heo EY
• Lee JS
• Yoon HI
• Lee JH
• Lee CT
• Kang YA

Abstract

Non-resolving or slowly resolving pulmonary infiltrates in spite of administering adequate antimicrobial therapy are a clinical diagnostic challenge for physicians. The rate of radiographic resolution varies with the patients' age, the underlying comorbidities, the extent of radiographic involvement, the functional status and the causal pathogens. It is important to differentiate non-resolving or slowly resolving bacterial pneumonia from other uncommon infectious pneumonias or malignancies that require invasive diagnostic techniques to confirm the diagnosis. Bronchioloalveolar carcinoma can present with various clinical and radiographic features. Unfortunately, the radiographic similarity of consolidative BAC to pneumonia often leads to an incorrect diagnosis of pneumonia and possibly significant delays in obtaining appropriate diagnostic studies. We describe here a case of a mixed adenocarcinoma and bronchioloalveolar carcinoma that was initially diagnosed as pneumonia due to the consolidation pattern on the radiography and the patient's initial improvement with antibiotic treatment.

Keyword

Bronchioloalveolar carcinoma; Consolidation; Non-resolving pneumonia

MeSH Terms

Adenocarcinoma
Adenocarcinoma, Bronchiolo-Alveolar
Comorbidity
Delayed Diagnosis
Pneumonia
Pneumonia, Bacterial

Figure

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  Figure 1 Initial chest CT (at admission) showed right lower lobe consolidation with pleural effusion and reactive LN enlargement.

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  Figure 2 Chest images at 16th day after admission showed improved right lower lobe consolidation and pleural effusion after 16 days of antibiotics therapy.

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  Figure 3 After 2 month of discharge, follow-up chest CT showed decreased pleural effusion but remaining consolidation was still observed at right lower lobe.

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  Figure 4 After 4 month of discharge, follow-up chest CT showed decreased but remaining consolidation with focal cavitation at right lower lobe.

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  Figure 5 Resected lung tissue showed mass with necrosis and bleeding.

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  Figure 6 Tumor cells showed mucinous-bronchioloalveolar pattern composed of tall columnar cells with basal nuclei and pale cytoplasm, resembling goblet cells, with varying amounts of cytoplasmic mucin. It also showd extensive consolidation with numerous alveolar macrophages (H&E stain, ×100).

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  Figure 7 The resected lung specimen showed invasion which was characterized by significant increase in cytologic atypia, a fibroblastic stromal reaction, and an acinar pattern of growth (H&E stain, ×200).

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