Tuberc Respir Dis.  2015 Apr;78(2):72-77. 10.4046/trd.2015.78.2.72.

Prevalence of Benign Diseases Mimicking Lung Cancer: Experience from a University Hospital of Southern Brazil

• Homrich GK
• Andrade CF
• Marchiori
• Lidtke GD
• Martins FP
• Santos JW

• KMID: 2320597
• DOI: http://doi.org/10.4046/trd.2015.78.2.72

Abstract

BACKGROUND
Lung cancer is the most lethal type of cancer in the world. Several benign lung diseases may mimic lung carcinoma in its clinical and radiological presentation, which makes the differential diagnosis for granulomatous diseases more relevant in endemic regions like Brazil. This study was designed to describe the prevalence and the diagnostic work-up of benign diseases that mimic primary lung cancer in patients hospitalized at a university hospital from south of Brazil.
METHODS
This was a transversal study, which evaluated the medical records of 1,056 patients hospitalized for lung cancer treatment from September 2003 to September 2013 at University Hospital of Santa Maria.
RESULTS
Eight hundred and four patients underwent invasive procedures for suspected primary lung carcinoma. Primary lung cancer was confirmed in 77.4% of the patients. Benign disease was confirmed in 8% of all patients. Tuberculosis (n=14) and paracoccidioidomycosis (n=9) were the most frequent infectious diseases. The diagnosis of benign diseases was obtained by flexible bronchoscopy in 55.6% of the cases and by thoracotomy in 33.4%.
CONCLUSION
Infectious diseases are the most frequent benign diseases mimicking lung cancer at their initial presentation. Many of these cases could be diagnosed by minimally invasive procedures such as flexible bronchoscopy. Benign diseases should be included in the differential diagnosis during the investigation for primary lung cancer in order to avoid higher cost procedures and mortality.

Keyword

Lung Neoplasms; Mimicking; Respiratory Tract Infections

MeSH Terms

Brazil*
Bronchoscopy
Communicable Diseases
Diagnosis
Diagnosis, Differential
Humans
Lung
Lung Diseases
Lung Neoplasms*
Medical Records
Mortality
Paracoccidioidomycosis
Prevalence*
Respiratory Tract Infections
Thoracotomy
Tuberculosis

Figure

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  Figure 1 Chest radiographs and chest and skull computed tomography (CT) scans of a 36-year-old male, smoker, with progressive dyspnea, weight loss, and productive cough. (A, B) Chest radiograph with opacity in the inferior lobe and in the left superior lobe. (C) Chest CT scan with voluminous lesion in the left lung. (D) Skull CT scan with nodular lesions in the brain hemispheres. Fibrobronchoscopy with biopsy of polypoid lesion in the bronchus of the left inferior lobe identified Cryptococcus sp. cultured with C. gatti growth.

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  Figure 2 Chest computed tomography (CT) scan of a 59-year-old patient, ex-smoker, retired farmer with evening fever for 2 weeks, weight loss, and pleuritic pain. Chest radiograph with nodular lesion in the left inferior lobe. Chest CT with juxta-pleural lesion in the left inferior lobe. A thoracotomy biopsy was performed. The histopathologic analysis showed granulomatous processes with areas of necrosis and fungus consistent with Paracoccidioides brasiliensis, confirmed by fungus growth in Sabouraud agar.

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  Figure 3 Chest computed tomography (CT) scan of a 70-year-old patient, retired farmer, smoker, alcoholic exhibits symptoms compatible with chronic obstructive pulmonary disease, progressing with loss of weight, cough, hemoptysis, and increased dyspnea. Chest radiograph with right perihilar opacity. Chest CT confirmed the finding. Fibrobronchoscopy with endobronchial biopsy of the lesion was performed and showed the presence of acid-fast bacilli, with confirmation of Mycobacterium tuberculosis in culture media.

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