DOI: 10.12890/2025_005790
The great mimicker: pulmonary adenocarcinoma with interstitial lung disease-like presentation
Authors
mupadhy2@hurleymc.com
Keywords
Interstitial lung disease (ILD), invasive mucinous adenocarcinoma (IMA), bronchoalveolar lavage (BAL), biopsy, pulmonary function test (PFT)Abstract
A 52-year-old female with a significant smoking history and newly diagnosed chronic obstructive pulmonary disease (COPD) presented to the emergency department with shortness of breath and blood-tinged sputum. Following a prior hospitalization for a COPD exacerbation, imaging revealed atypical features prompting autoimmune evaluations that were negative. A decline in pulmonary function led to admission for bronchoscopy, which revealed invasive mucinous adenocarcinoma (IMA). This case underscores the diagnostic challenges of IMA, which can mimic interstitial lung disease (ILD), resulting in delayed diagnosis and mismanagement. The high false-negative rate of bronchoalveolar lavage cytology in mucinous adenocarcinoma highlights the need for prompt tissue sampling in similar presentations for timely intervention.
References
- Hutchinson BD, Shroff GS, Truong MT, Ko JP. Spectrum of Lung Adenocarcinoma. Semin Ultrasound CT MR 2019Jun;40:255-264. doi: 10.1053/j.sult.2018.11.009
- Lantuejoul S, Colby TV, Ferretti GR, Brichon PY, Brambilla C, Brambilla E. Adenocarcinoma of the lung mimicking inflammatory lung disease with honeycombing. Eur Respir J 2004;24:502-505. doi: 10.1183/09031936.04.00124703
- Hata A, Hino T, Yanagawa M, Nishino M, Hida T, Hunninghake GM, et al. Interstitial Lung Abnormalities at CT: Subtypes, Clinical Significance, and Associations with Lung Cancer. Radiographics 2022;42:1925-1939. doi: 10.1148/rg.220073
- Khera R, Sharma RK, Kaushal M, Talwar D. Sticking to basics pays even today: Diagnosis of adenocarcinoma lung on sputum examination in patient reluctant to undergo biopsy - Providing opportunity for targeted therapy for palliation if not early detection. Lung India 2019;36:84-85. doi: 10.4103/lungindia.lungindia_337_18
- Xiong J, Polsdofer E, Jing J. Common practice issues in pulmonary cytology/small biopsy: Diagnostic pitfalls and appropriate use of immunohistochemical stains. Hum Pathol Rep 2024;36:300735. doi: 10.4103/lungindia.lungindia_337_18
- Gurda GT, Zhang L, Wang Y, Chen L, Geddes S, Cho WC, et al. Utility of five commonly used immunohistochemical markers TTF-1, Napsin A, CK7, CK5/6 and P63 in primary and metastatic adenocarcinoma and squamous cell carcinoma of the lung: a retrospective study of 246 fine needle aspiration cases. Clin Transl Med 2015;4:16. doi: 10.1186/s40169-015-0057-2
- Yatabe Y, Mitsudomi T, Takahashi T. TTF-1 expression in pulmonary adenocarcinomas. Am J Surg Pathol 2002;26:767-773. doi: 10.1097/00000478-200206000-00010
- Ge L, Wang L, Pei D. Pulmonary mucinous adenocarcinoma: An overview of pathophysiology and advancements in treatment. Heliyon 2024;10:e28881. doi: 10.1016/j.heliyon.2024.e28881
- Marks JL, Broderick S, Zhou Q, Chitale D, Li AR, Zakowski MF, et al. Prognostic and therapeutic implications of EGFR and KRAS mutations in resected lung adenocarcinoma. J Thorac Oncol 2008;3:111-116. doi: 10.1097/JTO.0b013e318160c607
- Chiner-Vives E, Cordovilla-Pérez R, de la Rosa-Carrillo D, García-Clemente M, Izquierdo-Alonso JL, Otero-Candelera R, et al. Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases. Arch Bronconeumol 2022;58:39-50. doi: 10.1016/j.arbres.2022.03.011
