Invasive Pulmonary Adenocarcinoma with Lepidic Growth Pattern in a Pregnant Patient

Abstract

Among the differential diagnoses that should be considered in acute respiratory failure (ARF) are infectious processes, autoimmune diseases, interstitial pulmonary fibrosis, and pulmonary neoplasia. Timely diagnosis of lung neoplasia is complicated in the early stages. An opportune diagnosis, as well as the specific treatment, decrease mortality. ARF occurs 1 in 500 pregnancies and is most common during the postpartum period. Among the specific etiologies that cause ARF during pregnancy that must be considered are: (1) preeclampsia; (2) embolism of amniotic fluid; (3) peripartum cardiomyopathy; and (4) trophoblastic embolism. The case of a 36-year-old patient with a 33-week pregnancy and ARF is presented. The patient presented dyspnea while exerting moderate effort that progressed to orthopnea and type 1 respiratory insufficiency. Imaging studies showed bilateral alveolar infiltrates and predominantly right areas of consolidation. Blood cultures, a galactomannan assay and IgG antibodies against mycoplasma pneumoniae, were reported as negative. Autoimmune etiology was ruled out through an immunoassay. A percutaneous pulmonary biopsy was performed and an invasive pulmonary adenocarcinoma with lepidic growth pattern (i.e. lepidic pulmonary adenocarcinoma, LPA) result was reported. This etiology is rare and very difficult to recognize in acute respiratory failure cases. After infectious, autoimmune and interstitial lung fibrosis have been excluded the clinician must suspect of lung cancer in a patient with acute respiratory failure and chest imaging compatible with the presence of ground-glass nodular opacities, a solitary nodule or mass with bronchogram, and lung consolidation. In the presence of acute respiratory failure, the suspicion of pulmonary neoplasia in an adult of reproductive age must be timely. Failure to recognize this etiology can lead to fatal results.

Non-mucinous adenocarcinoma: a unique case with a deceptive presentation

“…Weight loss and weakness have been observed in approximately 34.0% of patients, while coughing and dyspnea range from 45-54.7% and 37-45%, respectively. 7 In addition, chest pain and hemoptysis occurred in upwards of 27.0% of patients diagnosed with lepidic adenocarcinoma. 7 On imaging, chest x-ray will often reveal a coin-like lesion in the lung fields.…”

“…7 In addition, chest pain and hemoptysis occurred in upwards of 27.0% of patients diagnosed with lepidic adenocarcinoma. 7 On imaging, chest x-ray will often reveal a coin-like lesion in the lung fields. 4 Further evaluation through CT scan will show the presence of ground glass lesions and multiple sub-solid nodules.…”

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“…Weight loss and weakness have been observed in approximately 34.0% of patients, while coughing and dyspnea range from 45-54.7% and 37-45%, respectively. 7 In addition, chest pain and hemoptysis occurred in upwards of 27.0% of patients diagnosed with lepidic adenocarcinoma. 7 On imaging, chest x-ray will often reveal a coin-like lesion in the lung fields.…”

“…7 In addition, chest pain and hemoptysis occurred in upwards of 27.0% of patients diagnosed with lepidic adenocarcinoma. 7 On imaging, chest x-ray will often reveal a coin-like lesion in the lung fields. 4 Further evaluation through CT scan will show the presence of ground glass lesions and multiple sub-solid nodules.…”

Clinical features and intervention timing in patients with pregnancy-associated non-small-cell lung cancer

“…Use of targeted therapy during pregnancy should still be considered carefully because of the lack of data. Some patients did not receive any anticancer therapies due to poor general condition and rapid progression of lung cancer (32)(33)(34). The prognosis of such patients was poor.…”