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The Moth-Eaten Lung

Lung Adenocarcinoma with Cavitating Miliary intrapulmonary Carcinomatosis
  • Chor-Kuan Lim
    Correspondence
    Address for correspondence: Chor-Kuan Lim, MD, Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya South Road, Banciao District, New Taipei City 220, Taiwan
    Affiliations
    Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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      CASE PRESENTATION

      A 64-year-old man of Asian descent presented to our clinic because of dry cough and shortness of breath for 2 months. He was a never-smoker and denied tuberculosis exposure. His chest radiography showed diffuse miliary nodules distributed at bilateral lungs. The computed tomography of chest showed a 2.5-cm nodule at the superior segment of right lower lung and widespread of cavitating and noncavitating miliary nodules at bilateral lungs (Fig. 1). A diagnosis of stage IV lung adenocarcinoma with EGFR exon-19 deletion mutation was made.
      Figure thumbnail gr1
      FIGURE 1Chest computed tomography showed a 2.5-cm nodule at superior segment of right lower lung and widespread of cavitating and noncavitating miliary nodules at bilateral lung.
      The patient was treated with afatinib 40 mg per day. On afatinib treatment at 3 months, the chest computed tomography showed shrinkage of the main tumor and regression of the cavitating and noncavitating miliary nodules (Fig. 2). The patient is currently undergoing afatinib treatment with good partial response.
      Figure thumbnail gr2
      FIGURE 2On afatinib treatment at 3 months, the main tumor decreased in size, and the cavitating and noncavitating miliary nodules regressed.
      Lung is frequently a metastatic site for non–small-cell lung cancer. It can present as multiple lung nodules, lymphade-nopathy, and effusion on chest imaging.
      • Marom EM
      • Patz Jr, EF
      • Swensen SJ
      Radiologic findings of bronchogenic carcinoma with pulmonary metastases at presentation.
      Nevertheless, lung cancer with cavitating miliary carcinomatosis is extremely uncommon. It indicates a hematogenous dissemination of cancer cells and usually carries a rapidly fatal clinical course.
      • Hansell DM
      • Bankier AA
      • MacMahon H
      • McLoud TC
      • Müller NL
      • Remy J
      Fleischner Society: glossary of terms for thoracic imaging.
      • Umeki S
      Association of miliary lung metastases and bone metastases in bronchogenic carcinoma.
      Interestingly, this patient population has been shown to harbor a higher rate of adenocarcinoma and EGFR mutation, especially EGFR exon-19 deletion mutation.
      • Wu SG
      • Hu FC
      • Chang YL
      • et al.
      Frequent EGFR mutations in non-small cell lung cancer presenting with miliary intrapulmonary carcinomatosis.

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