CHEST Guidelines-Recurrent-Pneumonia,-Persistent-Cough,-and-Dyspnea

Recurrent-Pneumonia,-Persistent-Cough,-and-Dyspnea

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This document presents a clinical case study discussing a 41-year-old man with a history of bronchiectasis, recurrent pneumonia, and persistent respiratory symptoms who was eventually diagnosed with invasive mucinous adenocarcinoma (formerly called mucinous bronchioloalveolar carcinoma) alongside cryptogenic organizing pneumonia (COP). Despite an initial misdiagnosis of bronchiectasis, the patient presented with recurrent pneumonia over three years, persistent cough, and abnormal respiratory findings.<br /><br />Multiple chest CT scans revealed ground-glass opacities with consolidation in various lung lobes, and initial diagnostic tests, including bronchoscopy and cultures, were inconclusive. Subsequent video-assisted thoracoscopic surgery and biopsy indicated invasive mucinous adenocarcinoma, characterized by its multifocal spread and presence of columnar cells with mucin content.<br /><br />The distinction between different forms of adenocarcinoma is emphasized, where invasive mucinous adenocarcinoma is noted for its multifocal nature and poorer prognosis compared to nonmucinous types due to its extensive lung involvement and aggressive behavior. Immunohistochemical staining helped differentiate this type from other lung pathologies, with the presence of k-ras mutation and lack of EGFR mutation ruling out targeted therapy options.<br /><br />Concomitant COP, a pattern of lung injury characterized by lung tissue proliferation, was also diagnosed. It often presents similarly to pneumonia in imaging studies, complicating the diagnosis. Empirical treatment with corticosteroids and macrolides like erythromycin might offer relief depending on the underlying cause, potentially related to infectious agents or tumor responses.<br /><br />The document concludes by emphasizing the complexities in diagnosing and treating this rare combination of invasive mucinous adenocarcinoma and COP, particularly in staging, treatment, and follow-up due to overlapping clinical and radiological features. The case illustrates the necessity for comprehensive pathological assessments to inform appropriate management and therapeutic strategies.

Keywords

invasive mucinous adenocarcinoma

cryptogenic organizing pneumonia

bronchiectasis

recurrent pneumonia

ground-glass opacities

k-ras mutation

EGFR mutation

immunohistochemical staining

lung pathology

corticosteroids