Tuberc Respir Dis.  2011 Sep;71(3):216-220.

A Case of Non-Small Cell Lung Cancer in a Respiratory Bronchiolitis Associated Interstitial Lung Disease Patient

• Jhun BW
• Kim DM
• Park JH
• Jung H
• Song L
• Han J
• Chung MP

Abstract

Respiratory bronchiolitis-associated interstitial lung disease is one of the smoking-related interstitial lung diseases. Histopathologically, it shows respiratory bronchiolitis, which is characterized by the accumulation of pigmented macrophages within the respiratory bronchioles, accompanying peribronchiolar inflammation. Clinically, it is presented with respiratory symptoms such as a cough, sputum and dyspnea on exertion. It is well known that the incidence of malignancy in interstitial lung disease is high, but in respiratory bronchiolitis-associated interstitial lung disease the report of accompanying malignancy is rare. Here we report a case of a 60-year-old male heavy smoker presented with a cough, sputum and clubbing finger. A chest computed tomography (CT) of the patient did not show any shadow suspected of malignancy, but adenocarcinoma was found on a transbronchial lung biopsy and on a surgical lung biopsy with respiratory bronchiolitis-associated interstitial lung disease.

Keyword

Bronchiolitis; Lung Diseases, Interstitial; Carcinoma, Non-Small-Cell Lung

MeSH Terms

Adenocarcinoma
Biopsy
Bronchioles
Bronchiolitis
Carcinoma, Non-Small-Cell Lung
Cough
Dyspnea
Fingers
Humans
Incidence
Inflammation
Lung
Lung Diseases, Interstitial
Macrophages
Male
Middle Aged
Sputum
Thorax

Figure

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  Figure 1 Posteroanterior chest radiograph shows subpleural reticular opacity in both lower lung zones and small nodular lesion in left upper lung zone.

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  Figure 2 High resolution computed tomography shows peripheral ground-glass attenuation with multiple clustered air-filled cysts in the both lower lung zones and paraseptal emphysema in both upper lung zones. Well defined 10 mm sized calcified nodule was observed in left upper lobe.

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  Figure 3 Microscopic finding of transbronchial lung biopsy shows small adenocarcinoma in right lower lobe posterior basal segment (hematoxylin and eosin stain; A, ×100; B, ×400).

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  Figure 4 Microscopic findings of video-assisted thoracopscopic surgery biopsy shows many pigmented intraalveolar macrophages, peribronchial inflammation and patchy parenchymal and subpleural irregular fibrosis with lymphocytic infiltration (hematoxylin and eosin stain; A, ×100; B, ×400).

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