Invasive mucinous adenocarcinoma with lepidic-predominant pattern coexisted with tuberculosis: a case report

Abstract

We observed a rare case of invasive mucinous adenocarcinoma (IMA) with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml (reference value of negative is<14 pg/ml), Mycobacterium tuberculosis culture was positive, and tuberculin skin test (PPD) was negative (skin induration<5 mm). The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic-predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.

Keywords

invasive mucinous adenocarcinoma / lepidic-predominant / tuberculosis

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Conclusions

Diagnosing the simultaneous occurrence of pulmonary tuberculosis and adenocarcinoma is challenging, considering that one can mask the other, especially when the tumor has a lepidic growth pattern. Biopsy specimens for histological must be considered to obtain a definite diagnosis as soon as possible.

Acknowledgements

The support from National Natural Science Foundation of China (No. 81200017) is gratefully acknowledged.

Compliance with ethics guidelines

Xinxin Xu, Yinshi Guo, Qiuying Li, Ling Yang, and Jianqiang Kang declared that they have no conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

RIGHTS & PERMISSIONS

2017 Higher Education Press and Springer-Verlag Berlin Heidelberg