Invasive Lung Adenocarcinoma Mimicking Nodular Tuberculosis in a HIV Positive Patient (Case report)

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Even though there are many similarities in symptoms and radiological aspect between pulmonary tuberculosis (TB) and lung neoplasia, there are many differences between them like different etiologies, different consequences, and altogether different management. We present a case of a 59 years old male, heterosexual, who was HIV diagnosed in the last 16 years. He had a good immunological and virusological evolution over the time. In the last 5 months of his life he was diagnosed with pulmonary TB and he received specific treatment. After 4 months of antituberculous treatment patient became asthenic, febrile, with productive cough, and weight loss. Imagistic evolution was unfavorable. The suspicion of pulmonary neoplasm raises in the last 3 weeks of his life. Macroscopic lung examination during autopsy was suggestive rather to a pulmonary TB than a lung neoplasm, with a nodular pattern very similar with nodular TB. Histopathological examination evidenced a lung adenocarcinoma.

In HIV patients a delayed or missed diagnosis of lung cancer, can lead to late treatment or wrong treatments, and finally death of patient.

1. Bhatt, M., Kant, S. & Bhaskar, R. (2012). Pulmonary tuberculosis as differential diagnosis of lung cancer. South Asian J Cancer. 1, 36-42. DOI: 10.4103/2278-330X.96507

2. Chirilă, S., Rugină, S. & Broască, V. (2014). Neoplastic Diseases Incidence in Constanta County During 2007 - 2012. ARS Medica Tomitana. 20(4), 211 - 214. DOI: 10.1515/arsm-2015-0008

3. Ferraresi, A., Calabresi, A., Castelli, F., Vavassori, A., Castelnuovo, F., Scalzini, A., Torti, C. & Quiros-Roldan, E. (2012). Lung cancer in HIVinfected patients: the experience in Brescia from 1999 to 2009. Int J STD AIDS. 23(10), 753-735. DOI: 10.1258/ijsa.2012.012042

4. Mani, D., Haigentz, M.Jr. & Aboulafia, D.M. (2012). Lung cancer in HIV Infection. Clin Lung Cancer. 13(1), 6-13. DOI: 10.1016/j. cllc.2011.05.005

5. Pakkala, S. & Ramalingam, S.S. (2010). Lung Cancer in HIV-Positive Patients. Journal of Thoracic Oncology. 5(11), 1864-1871. DOI: 10.1097/JTO.0b013e3181f387fd

6. Arbune, M. (2013). Characteristic of HIV late presenters in south-eastern Romania. Acta Medica Mediterranea. 29(1), 71- 75

7. Engels, E.A., Brock, M.V., Chen, J., Hooker, C.M., Gillison, M. & Moore, R.D. (2006). Elevated incidence of lung cancer among HIVinfected individuals. J Clin Oncol. 24, 1383-1388

8. Kirk, G.D., Merlo, C., O’Driscoll, P., Mehta, S.H., Galai, N., Vlahov, D., Samet, J. & Engels, E.A. (2007). HIV infection is associated with an increased risk for lung cancer, independent of smoking. Clin Infect Dis. 45, 103-110

9. Shebl, F.M., Engels, E.A., Goedert, J.J. & Chaturvedi, A.K. (2010). Pulmonary infections and risk of lung cancer among persons with AIDS. J Acquir Immune Defic Syndr. 55, 375-379

10. Spano, J.P., Massiani, M.A., Bentata, M., Rixe, O., Friard, S., Bossi, P., Rouges, F., Katlama, C., Breau, J.L., Morere, J.F., Khayat, D. & Couderc, L.J. (2004). Lung cancer in patients with HIV Infection and review of the literature. Med Oncol. 21(2), 109-115

11. Travis, W.D., Brambilla, E., Noguchi, M., Nicholson, A.G. & Geisinger, K.R. et al. (2011). International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 6(2), 244-285. DOI: 10.1097/ JTO.0b013e318206a221

12. Yoshizawa, A., Motoi, N., Riely, G.J., Sima, C.S., Gerald, W.L., Kris, M.G., Park, B.J., Rusch, J.W. & Travis, W.D. (2011). Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases. Modern Pathology; 24, 653-664. DOI: 10.1038/ modpathol.2010.232

13. Makimoto, Y., Nabeshima, K., Iwasaki, H., Miyoshi, T., Enatsu, S., Shiraishi, T., Iwasaki, A., Shirakusa, T. & Kikuchi, M. (2005). Micropapillary pattern: a distinct pathological marker to subclassify tumors with a significantly poor prognosis within small peripheral lung adenocarcinoma (≤20 mm) with mixed bronchioloalveolar and invasive subtypes (Noguchi's type C tumors). Histopathology. 46(6), 677-684. DOI: 10.1111/j.1365-2559.2005.02126.x

ARS Medica Tomitana

The Journal of "Ovidius" University of Constanta

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