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Centrally Located Squamous Cell Carcinoma of the Lung Mimicking Endobronchial Tuberculosis

      Abstract

      Here we report a case of centrally located squamous cell carcinoma of the lung mimicking endobronchial tuberculosis. On the basis of the white light bronchoscopic (WLB) findings, bronchial tuberculosis was initially suspected. But transbronchial biopsy of the lesion revealed squamous cell carcinoma. Autofluorescence imaging bronchovideoscopy (AFI) showed the lesion area as magenta. After four cycles of chemotherapy, the magenta area was markedly shrunk on AFI. Performance of AFI might be useful for differentiating centrally located lung cancer from endobronchial tuberculosis.

      Keywords

      CASE REPORT

      An 88-year-old man presented with a productive cough and hemoptysis for 3 months. The chest x-ray film and computed tomography scans showed a left lower lobe mass and peripheral atelectasis. Conventional white light bronchoscopy (WLB) revealed swollen and hyperemic mucosa diffusely covered with white material that extended from the left main bronchus to the peripheral bronchi (Figure 1A). Autofluorescence imaging (AFI) bronchovideoscopy (Olympus Optical Corporation, Tokyo, Japan) showed the lesion area as magenta (Figure 1B). Based on the WLB findings, bronchial tuberculosis was initially suspected. Gaffky smear and polymerase chain reaction of the bronchoscopic samples were performed twice, but all tests were negative for acid fast bacilli. Then transbronchial biopsy of the left main bronchus revealed squamous cell carcinoma.
      Figure thumbnail gr1
      FIGURE 1A, Conventional white light bronchoscopy (WLB) reveals swollen and hyperemic mucosa diffusely covered with white material. B, Autofluorescence imaging (AFI) shows the lesion as a magenta area.
      The patient was diagnosed with stage IIIb squamous cell carcinoma of the lung (T4N0M0). He was treated with four cycles of docetaxel therapy (60 mg/m2 on day 1 every 3 weeks). After these four cycles of chemotherapy, the whitish lesion was reduced on WLB (Figure 2A), and the magenta area was markedly shrunk on AFI (Figure 2B).
      Figure thumbnail gr2
      FIGURE 2A, After four cycles of docetaxel therapy, conventional white light bronchoscopy (WLB) shows decrease of the whitish lesion. B, After four cycles of docetaxel therapy, autofluorescence imaging (AFI) demonstrates marked shrinkage of the magenta area.
      As occurred in this case, centrally located squamous cell carcinoma can manifest as bronchial lesions diffusely covered with white material on WLB alone, which is also the most frequent WLB finding of endobronchial tuberculosis.
      • Chung HS
      • Lee JH
      Bronchoscopic assessment of the evolution of endobronchial tuberculosis.
      Recently, AFI has improved the diagnostic precision of fluorescence bronchoscopy and can accurately and objectively distinguish malignant lesions from bronchitis.
      • Chiyo M
      • Shibuya K
      • Hoshino H
      • et al.
      Effective detection of bronchial preinvasive lesions by a new autofluorescence imaging bronchovideoscope system.
      As in this case, performance of AFI might be useful for differentiating centrally located lung cancer from endobronchial tuberculosis.

      REFERENCES

        • Chung HS
        • Lee JH
        Bronchoscopic assessment of the evolution of endobronchial tuberculosis.
        Chest. 2000; 117: 385-392
        • Chiyo M
        • Shibuya K
        • Hoshino H
        • et al.
        Effective detection of bronchial preinvasive lesions by a new autofluorescence imaging bronchovideoscope system.
        Lung Cancer. 2005; 48: 307-313