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• W2894565897 abstract "SESSION TITLE: Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/09/2018 07:30 am - 08:30 am INTRODUCTION: Cavitary lung disease is a frequent presentation of a variety of pathological processes involving the lungs. The differential diagnosis is broad and often requires a comprehensive evaluation to diagnose and appropriately manage. CASE PRESENTATION: An 83 year-old Caucasian man, former smoker, was referred for incidental multiple pulmonary nodules. He had a past medical history of prostate adenocarcinoma requiring radical prostatectomy and salvage external-beam radiotherapy with hormonal therapy for local recurrence. The prostate specific antigen (PSA) was undetectable following treatment; however, there was a subsequent increase up to 3.0 ng/ml. Surveillance computed tomography (CT) of the chest, abdomen, and pelvis revealed multiple bilateral pulmonary nodules and thin-walled cavities without thoracic or abdominal lymphadenopathy. Notably, bone scan did not reveal any bone metastasis. He was asymptomatic and denied any family history of lung cancer. Exposure history included asbestos while working on the ships while in the military. PET-CT showed low level metabolic activity in those lesions and no abnormality outside the chest. Autoimmune, fungal and tuberculosis serologies were negative. Bronchoscopy with bronchoalveolar lavage and bronchial brushings were sterile, and cytology was negative for malignancy. CT-guided biopsy of the dominant lesion was positive for adenocarcinoma. Immunohistochemical stains were only immunoreactive for PSA and nonreactive for CK7, CK20, GATA3, CDX2, Napsin A, p40, TTF-1, PAX8 and mucicarmine. These findings favored the diagnosis of prostate adenocarcinoma metastatic to the lungs. He declined surgical castration and started on androgen deprivation therapy with bicalutamide, leuprolide, abiraterone and prednisone. DISCUSSION: With serum serology and diagnostic bronchoscopy negative for infection, the main differential diagnosis was malignancy. Despite risk factors for primary lung cancer, the immunohistochemical stains were negative in this regard. Lung metastasis in prostate cancer is uncommon and almost always occurs with bone metastases. The typical radiological presentation is that of lymphangitic carcinomatosis. Other radiographic presentations include: solitary nodule(s), pleural effusion, and/or lymphadenopathy. To our knowledge, this is the first reported case of cavitary pulmonary metastasis from prostate cancer in the absence of bone or lymphatic metastasis. CONCLUSIONS: Malignancy is one the most important noninfectious causes of cavitary lung disease. In the appropriate clinical setting, metastatic prostate cancer should be considered in the workup of lung cavities even in the absence of osseous metastasis. Reference #1: Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev 2008;21(2):305–333, table of contents. Reference #2: Maebayashi T, Abe K, Aizawa T, et al. Solitary pulmonary metastasis from prostate cancer with neuroendocrine differentiation: a case report and review of relevant cases from the literature. World J Surg Oncol 2015;13:173 Reference #3: Fabozzi SJ, Schellhammer PF, Mahdi AM el-. Pulmonary metastases from prostate cancer. Cancer 1995;75(11):2706–2709 DISCLOSURES: No relevant relationships by Charles Burger, source=Web Response No relevant relationships by Rami Manochakian, source=Web Response No relevant relationships by Neal Patel, source=Web Response No relevant relationships by Ali Zaied, source=Web Response" @default.
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• W2894565897 date "2018-10-01" @default.
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• W2894565897 title "CAVITARY LUNG DISEASE: AN EXTREMELY RARE ETIOLOGY" @default.
• W2894565897 doi "https://doi.org/10.1016/j.chest.2018.08.415" @default.
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