Adenocarcinoma of the lung mimicking inflammatory lung disease with honeycombing

Abstract

Pulmonary adenocarcinoma of the lung and its variants are well-defined entities, since the recent WHO classification of lung tumours. However, scant descriptions have been allocated to associated stromal changes, such as prominent inflammation and fibrosis, which can overshadow a tumoral proliferation and masquerade as a benign reactive process and this has not been recognised as a histopathological variant.The case of a 72-yr-old farmer who presented a multifocal well-differentiated adenocarcinoma that mimicked honeycomb lung with bronchiolectasis radiologically, on computed tomography scan and histologically at open lung biopsy, is reported. Histological pitfalls in the biopsy were represented by mild atypical cuboidal or columnar epithelial cells lining bronchiolar structures resembling florid bronchiolar metaplasia in a background of extensive fibrosis and inflammation, features that mimicked inflammatory honeycombing. However, histological analysis of the surgical resection of the main lesion, performed because of a clinical alteration of the patient, confirmed the diagnosis of multifocal adenocarcinoma of mixed subtype. A monomorphic proliferation of clear cells, lack of associated ciliated or squamous cells and presence of significant cytologic atypia gave a diagnosis of malignancy.This case illustrates how inflammatory and fibrotic changes may conceal a correct diagnosis of carcinoma and emphasises the importance of adequate sampling in such cases. Eur Respir J 2004; 24: 502-505.

Benign features of infection‐related tumor‐like lesions of the lung: A retrospective imaging review study

“…The specific frequencies of the rest three features were not found in the literature but some descriptions of the relation with lung malignancy were noted. Architectural distortion was less common condition in lung malignancy . Comet tail sign was specific to benign rounded atelectasis but searching for concurrent malignant signs was required to rule out malignancy .…”

“…Architectural distortion was less common condition in lung malignancy. 32 Comet tail sign was specific to benign rounded atelectasis but searching for concurrent malignant signs was required to rule out malignancy. 20 Bronchiectasis was a potential risk for lung malignancy; therefore, coexistence of bronchiectasis and lung malignancy was not unusual.…”

Occult Adenocarcinoma of the Lung Mimicking Rapid Progression of Asbestosis

“…This phenomenon has been mentioned in the literature (1,2), but only a few cases have been reported with a limited description of how it progresses over time (3,4). Here, we present an unusual case of fatal occult lung adenocarcinoma with marked reactive fibrosis that mimicked progression of preexisting asbestosis over a period of years.…”

“…Tumor cells were sparse or even missing in some areas of fibrotic scarring. As Lantuejoul et al noted (4), transbronchial biopsies could be insufficient to make a correct diagnosis in this setting, and, ideally, surgical lung biopsy should be considered to obtain adequate tissue sampling.…”

When Malignancies Mimic Interstitial Lung Disease: A Case Series and Review of the Literature

“…Adenocarcinoma of the lung has been reported in the literature mimicking "benign" processes such as pneumonia [6], desquamative interstitial pneumonia (DIP) [7] or lung fibrosis with honeycombing [8]. Lymphangiosis carcinomatosa can also present as ILD due to thickening of the bronchovascular bundles prominent in the axial compartment and/or thickened peripheral interlobular septa shaping a polygonal pattern [9].…”