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Lung Cancer with Unusual Presentation as a Thin-Walled Cyst in a Young Nonsmoker

  • Chou-Chin Lan
    Affiliations
    Division of Pulmonary Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan, Republic of China

    School of Medicine, Tzu-Chi University, Hualien, Taiwan, Republic of China
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  • Hong-Cheng Wu
    Correspondence
    Address for correspondence: Dr. Yao-Kuang Wu, Division of Pulmonary Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, 289 Jianguo Road, Xindian City, Taipei County 23142, Taiwan, Republic of China
    Affiliations
    School of Medicine, Tzu-Chi University, Hualien, Taiwan, Republic of China

    Division of Hematology and Oncology, Taiwan, Republic of China
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  • Chih-Hsin Lee
    Affiliations
    Division of Pulmonary Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan, Republic of China

    School of Medicine, Tzu-Chi University, Hualien, Taiwan, Republic of China
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  • Shiu-Feng Huang
    Affiliations
    Department of Pathology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan, Republic of China

    Department of Pathology, School of Medicine, Tzu-Chi University, Hualien, Taiwan, Republic of China
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  • Yao-Kuang Wu
    Affiliations
    Division of Pulmonary Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan, Republic of China

    School of Medicine, Tzu-Chi University, Hualien, Taiwan, Republic of China
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      A 27-year-old female nonsmoker ever had received a healthy examination of chest radiography (CXR) with normal result 1 year ago. She consulted our institute because of prolonged cough for the past 3 months. She underwent CXR and this showed a thin-walled cyst in the right lower lung with ipsilateral hilar enlargement (Figure 1A). The chest CT showed a 30 × 30-mm cystic lesion in the right lower lung with hilar lymphadenopathy. Mycobacterial smears and cultures of obtained sputum were negative. Her carcinoembryonic antigen level was in the normal range. However, given that the appearance of the large cyst with hilar enlargement was atypical, the bronchoscopic examination was performed and revealed an endobronchial mass at the orifice of the right lower lobe (Figure 1B). The histologic examination of transbronchial biopsy specimens confirmed lung adenocarcinoma. Positron emission tomography revealed heterogeneous uptake of the cystic lesion, right hilar, mediastinal, and left neck lymph nodes, suggestive of metastasis. The patient was diagnosed as having stage IIIb lung cancer, T2N3M0. She underwent chemotherapy and external irradiation to the mediastinal and left neck lymph nodes. Her disease course was rapid. She succumbed to her tumor within 6 months of diagnosis.
      Figure thumbnail gr1
      FIGURE 1A, Chest radiography showed a 30 × 30 mm cystic lesion in the right lower lung with ipsilateral hilar enlargement. B, Bronchoscopic examination revealed an endobronchial mass at the orifice of the right lower lobe.
      The most common radiologic manifestation in lung cancer is solitary or multiple nodules. This report describes a case of lung adenocarcinoma presenting as a cystic lesion in a young nonsmoker, which is extremely rare. However, this atypical presentation of lung cancer should be kept in mind in the differential diagnosis.
      • Wigh R
      • Gilmore FR
      Solitary pulmonary necrosis: a comparison of neoplastic and inflammatory conditions.
      It should be possible to make a definite diagnosis of benign or malignant cystic masses. There are many hypotheses of cyst formation in malignancy including a check-valve obstruction at the conducting bronchus, central necrosis within the tumor, and development in preexisting cystic lesions.
      • Ohba S
      • Takashima T
      • Hamada S
      • et al.
      Multiple cystic cavitary alveolar-cell carcinoma.
      • Maki D
      • Takahashi M
      • Murata K
      • et al.
      Computed tomography appearances of bronchogenic carcinoma associated with bullous lung disease.
      This is the first case reported with tumor imaging at the conducting bronchus that supports the hypothesis of cyst formation due to a check-valve obstruction at the conducting bronchus.

      REFERENCES

        • Wigh R
        • Gilmore FR
        Solitary pulmonary necrosis: a comparison of neoplastic and inflammatory conditions.
        Radiology. 1951; 56: 708-716
        • Ohba S
        • Takashima T
        • Hamada S
        • et al.
        Multiple cystic cavitary alveolar-cell carcinoma.
        Radiology. 1972; 104: 65-66
        • Maki D
        • Takahashi M
        • Murata K
        • et al.
        Computed tomography appearances of bronchogenic carcinoma associated with bullous lung disease.
        J Comput Assist Tomogr. 2006; 30: 447-452