AB040. Bilateral nodular lung opacities with a benign course in a patient with resected pulmonary adenocarcinoma

Abstract: Adenocarcinoma is the most common histologic type of lung cancer. Most lung cancers are not localized when first detected, but early detection is mandatory to improve prognosis. We present the case of a 51-year-old Caucasian female patient, current smoker. Due to a right breast tumor resection, she underwent preoperative evaluation where on chest CT scan detected 1.3 cm nodule in lingula and 1.2 cm nodule in RLL. The nodule in the breast proved benign, so the patient went into PET-CT scan: uptake r/p of the lingula nodule. Bronchoscopy was without endobronchial findings. The patient submitted for left upper lobectomy, resection of RLL nodule (negative for malignancy) and lymph node cleaning. Histological examination determined adenocarcinoma stage Ia. She remained under follow up for the next 3 years, when a detailed re-examining revealed in chest CT scan bilateral nodular interstitial infiltrates localized mainly in the middle and upper right lung lobe. The patient was asymptomatic, with negative bronchoscopy/BAL and PET-CT scan. Screening for infections, specific infections and autoimmunity was also negative. Then it decided to perform open lung biopsy from RUL. Histological examination was negative for malignancy or specific inflammation. It revealed NSIP pattern with mild to moderate chronic inflammatory infiltration of the interstitial tissue. The patient is being closely monitored and remains disease-free for 6 years. There was no clinical, laboratory or radiography variation over the last 2 years of her monitoring. The presence of multiple nodules in the lungs is a common finding of metastatic malignancy, but several non-malignant diseases may also present with a similar radiological pattern. The assessment and diagnostic process should be fast, to be thorough and invasive if necessary in order to rule out or confirm metastatic disease and to take the correct treatment decisions.

Keywords: Lung adenocarcinoma; surgery; benign bilateral nodular lung opacities