Lung adenocarcinoma with multiple cavitary lung lesions

Abstract

A 68-year-old Asian woman was referred to our department because of an abnormal chest X-ray showing multiple patchy consolidative nodules and cavitary lesions, suggestive of a wide range of differential diagnoses, including infection, metastatic tumour, connective tissue disease and vasculitis. The patient had no relevant medical, medication or smoking histories. Chest CT revealed multiple diffuse, thick-walled, cavitary lung lesions with nodules and surrounding consolidation in both lung fields (figure 1, upper row). The laboratory findings revealed white blood cell, 8000/µL (Neu, 69.2%; Lym, 22.2%; Mono, 7.0%); C-reactive protein, 3.59 mg/dL; lactate dehydrogenase, 177 U/L; Beta-D-Glucan, <5 pg/mL; Aspergillus antigen, (−); perinuclear/cytoplasmic antineutrophil cytoplasmic antibody, (−); and interferon-gamma release assay for tuberculosis, (−). The only tumour marker significantly elevated was carbohydrate antigen 19–9 (CA19-9; 1072.7 U/mL; reference range: 0–37 U/mL). The bilateral cavitary lesions and laboratory findings suggested metastasis of an intra-abdominal cancer such as pancreatic cancer. However, contrast-enhanced abdominopelvic CT and whole-body positron emission tomography (PET-CT) revealed no evidence of abdominal, retroperitoneal or gynaecological tumours (figure 1, right). Transbronchial lung biopsy from right segment 6, the largest, most accessible lesion with intense uptake on PET-CT, revealed a lung adenocarcinoma (Napsin A positive; thyroid transcription factor 1 negative) with …