CHEST Guidelines-A-53-Year-Old-Man-With-a-Bronchial-Mass-and-Multip (1)

A-53-Year-Old-Man-With-a-Bronchial-Mass-and-Multip (1)

Pdf Summary

A 53-year-old man presented with back pain and numbness and weakness in his left limbs, along with a significant weight loss of 11 kg over three months. Despite no respiratory complaints, imaging revealed a 2.4 cm necrotic mass in the subcarinal mediastinum extending into the left bronchus, accompanied by multiple bone lesions, indicative of metastases. Bronchoscopy identified a highly vascular tumor in the bronchus, and biopsies confirmed the diagnosis of adenoid cystic carcinoma of the lung (ACCL) through characteristic histological and immunohistochemical findings, including the presence of myoepithelial cells lined by a network of tumor cells, and positivity for cytokeratin 7 and c-kit.<br /><br />ACCL is a rare type of lung tumor, comprising only 0.04% to 0.2% of lung cancers. It's typically slow-growing but has a tendency for local recurrence and metastasis. Most cases present in the fourth to sixth decade of life and have a slight male predominance; smoking is not a recognized risk factor. ACCL is challenging to treat, primarily via surgical resection, although advanced cases like this one may require chemotherapy and radiation therapy due to widespread metastasis.<br /><br />Histologically, ACCL is characterized by cribriform, tubular, or solid morphologies, without high-grade aggressive features. It tends to infiltrate local tissue, possibly explaining the patient's bone metastases. Due to this invasiveness and the lack of substantial environmental or lifestyle causes, treatment is complex. This patient is scheduled for systemic chemotherapy and radiation therapy, as surgical options are not feasible due to extensive metastases. Despite its complexity, early diagnosis and resection improve prognosis significantly.

Keywords

adenoid cystic carcinoma

lung cancer

metastasis

bronchoscopy

systemic chemotherapy

radiation therapy

histological findings

immunohistochemical findings

myoepithelial cells

necrotic mass