Lung cancer in patients with chronic empyema

Transcription

1 Lung cancer in patients with chronic empyema Poster No.: P-0025 Congress: ESTI 2015 Type: Scientific Poster Authors: Y. Lee, C.-K. Park; Guri/KR Keywords: Neoplasia, Biopsy, PET-CT, CT, Thorax, Lung DOI: /esti2015/P-0025 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 11

2 Purpose To evaluate the radiologic and clinical findings of lung cancers associated with chronic empyema. Materials and Methods We reviewed chest CT scans between February 2014 and January 2015 in our hospital. Among them, patients with chronic empyema and lung cancer were found in three patients. We included patients with their lung cancers in contact with chronic empyema (n=2). We also evaluated their clinical findings. Results Cases The first patient was a 73 year-old male with history of pulmonary tuberculosis 40 years ago, whose complaint was cough and sputum. The second patient was a 49 year-old male with history of pulmonary tuberculosis 4 years ago, who is admitted for work up of increased consolidation during 10 months. Radiologic finding Both tumors were presented as lung parenchymal consolidation. The 1st patient had the calcified chronic empyema in the right hemithorax and 8.8 cm lung cancer was in the right lower lobe. (Fig.1,3). The thickest portion of calcified chronic empyema was 1.1 cm (from visceral pleura to parietal pleura). Page 2 of 11

3 Fig. 1: The Patient 1. Enhanced CT images (the upper left two images) show the right lower lobe superior and right lower lobe basal consolidation. The right lower lobe superior bronchus is obstructed. Non-contrast HRCT image (the lower left image) shows lymphangitic spread around the tumor. PET CT MIP frontal view (the right image) shows diffuse increased uptake of RLL consolidation (SUV max =4.0); the right paratrachal and left supraclavicular lymph node metastasis; and C4, the left sacrum and left acetabular metastasis. References: Department of Radiology, Hanyang University Guri Hospital, Republic of Korea The 2nd patient had calcified chronic empyema in the left hemithorax and the 6.0cm lung cancer was in the left upper lobe. He also had smaller presumed synchronous lung cancers in the left lower lobe and right middle lobe. The differential diagnosis of right middle lobe lesion was tuberculosis or NTM infection. (Fig. 2). The patient had pleural calcification and small calcified chronic empyema in the right lower hemithorax. The thickest portion of calcified chronic empyema was 1.3 cm (from visceral pleura to parietal pleura). Page 3 of 11

4 Fig. 2: The Patient 2. The left upper lobe consolidation adjacent calcified chronic empyema shows avid FDG uptake (SUV max=12.1) References: Department of Radiology, Hanyang University Guri Hospital, Republic of Korea Diagnosis Both patients showed increased consolidation in chest X-ray compared to older films, which raised suspicion for lung cancer. (Fig. 3) Page 4 of 11

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6 Fig. 3: Patient 1. The first row images Chest PA and Chest left lateral taken 5.3 years ago from presentation. Images show contraction of the right hemithorax with pleural thickening and calcification. The right upper lung zone had apical capping and fibrocavitary changes. The second row images taken 9 months ago. On the left lateral view, consolidation in the right lower lobe superior increase. The third row images are at presentation. Consolidation in the left lower lobe increase with volume loss. References: Department of Radiology, Hanyang University Guri Hospital, Republic of Korea The 1st case was diagnosed by bronchoscopic biopsy and washing. The 2nd case was confirmed by percutaneous transthoracic needle biopsy Fig. 2) and bronchoscopic brushing and washing. Histology The histologic types were both adenocarcinoma. The 2nd case was adenocarcinoma with micropapillary component. EGFR mutation Both cases had EGFR mutation in exon 19, but exact mutation was different. Initial stage Both patients had bone metastasis at presentation. The 1st patient had ipsilateral mediastinal and contralateral supraclavicular lymph node metastasis on PET CT and CT. The 2nd patient had ipsilateral mediastinal and upper abdominal lymph node metastasis and liver metastasis on PET CT and CT. The 2nd patient had brain metastasis on PET CT and MR. Tuberculosis Bronchial aspirates were AFB negative in both patients. The 1st patient was culture positive for Mycobacterium tuberculosis. Both patients had history of tuberculosis 40 year ago and 4 year ago, respectively. PET CT SUV max of the lung cancer was 4.0 (Fig. 1) and 12.1 (Fig. 2), respectively. Page 6 of 11

7 Treatment The 1st patient underwent Alimta +Cisplatin therapy, then Irresa. After Tuberculosis culture positive, he underwent tuberculosis medication. The right lower lobe consolidation decreased after Alimta +Cisplatin therapy. The CT 50 days after starting Irresa which is 45 days after starting tuberculosis medication showed more decrease of RLL consolidation and decrease of left supraclavicular lymph node. (Fig. 4). This state had been maintained for 13 months. Fig. 4: The Patient 1. The coronal image of right hemithorax at bronchus intermedius level. The left image is at presentation. The middle image is after first chemotherapy. The right image is 50 days after starting Irresa which is 45 days after starting tuberculosis medication. The right lower lobe consolidation and lymphangitic metastasis are decreasing. References: Department of Radiology, Hanyang University Guri Hospital, Republic of Korea The 1st patient underwent Alimta +Cisplatin therapy, then Irresa. The lung cancer and liver metastasis decreased after Irresa therapy (3.5 months after presentation) (Fig. 5). The patient had been on radiation therapy and steroid for brain metastasis. Page 7 of 11

8 Fig. 5: The patient 2. The left image is taken before the biopsy of the left upper lobe consolidative lesion. The right image is 3.5 months later. The patient underwent chemotherapy between the images. References: Department of Radiology, Hanyang University Guri Hospital, Republic of Korea Images for this section: Page 8 of 11

9 Fig. 4: The Patient 1. The coronal image of right hemithorax at bronchus intermedius level. The left image is at presentation. The middle image is after first chemotherapy. The right image is 50 days after starting Irresa which is 45 days after starting tuberculosis medication. The right lower lobe consolidation and lymphangitic metastasis are decreasing. Page 9 of 11

10 Fig. 5: The patient 2. The left image is taken before the biopsy of the left upper lobe consolidative lesion. The right image is 3.5 months later. The patient underwent chemotherapy between the images. Page 10 of 11

11 Conclusions In our study, lung cancer associated with chronic empyema was adenocarcinoma and radiologic finding was consolidation. The patients had history of tuberculosis. The chronic empyema was calcified chronic empyma with less than 1.5cm thickness. Distant metastasis was present at presentation. Personal Information Youkyung Lee, MD, PhD. Assistant professor. Department of Radiology, Hanyang University Guri Hospital, Hanyng University College of Medicine, Republic of Korea Page 11 of 11