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• W3092699699 abstract "SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lung cancer is the leading cause of cancer related death in United States with non-small cell lung cancer (NSCLC) accounting for 87% of all cases. Sub-types of lung cancers are characterized by key features noted on Computed tomography scan, peculiar for each sub-type. It is important however to entertain NSCLC on the differential despite atypical imaging features that incline more towards other etiologies. We are presenting a rare radiological manifestation of NSCLC with the aim to increase awareness among physicians and to also highlight the increasing prevalence of NSCLC in military personnel CASE PRESENTATION: 36 year-old veteran non-smoker with no significant past medical history presented to the ED for a nonproductive cough of 3-week duration. He denied fever, night sweats orweight loss. Two family members were recently diagnosed and treated with pneumonia. He was deployed in Afghanistan, Kuwait and Jordan one year ago. Extensive blood work including blood culture, Quantiferon Gold and viral panel was unremarkable. Outpatient chest Xray demonstrated innumerable bilateral micronodules with small right pleural effusion. CT Chest again showed innumerable bilateral pulmonary nodules and noted a consolidative process within right lower lung associated with pleural effusion. Infectious etiologies including pulmonary tuberculosis, bacterial, viral and fungal pneumonia were unlikely seeing the clinical course and the negative blood and sputum cultures.. A diagnostic thoracentesis was performed and pleural fluid analysis yielded lymphocytic predominant exudative effusion. Pleural fluid cytology was positive for primary lung adenocarcinoma DISCUSSION: NSCLC have typical key characteristics on imaging for different subtypes. Squamous cell carcinoma typically present as central masses, whereas adenocarcinoma are typically peripherally located and measure <4 cm in diameter. In our case chest radiography was consistent with a miliary type appearance, not characteristic of any of the NSCLC. Extensive review of the literature showed 15 cases of adenocarcinoma of the lung presenting similarly with intrapulmonary miliary metastasis. In the reported case sick contact and travel history biased our differential diagnosis. CONCLUSIONS: Miliary pattern in chest radiography is very rare in primary lung cancer. Upon further literature review it has been found that military personnel are being more commonly affected by NSCLC. This is the first case of adenocarcinoma of the lung presenting as miliary metastasis in a young non smoking male. Reference #1: Pillai S, Khan A, Khan S (August 19, 2019) Adenocarcinoma of the Lung Presenting with Intrapulmonary Miliary Metastasis. Cureus 11(8): e5430. doi:10.7759/cureus.5430 Reference #2: Brzezniak, C., Satram-Hoang, S., Goertz, HP. et al. J GEN INTERN MED (2015) 30: 1406. https://doi.org/10.1007/s11606-015-3280-z Reference #3: Survival among Lung Cancer Patients in the U.S. Military Health System: A Comparison with the SEER Population Jie Lin, Christine Kamamia, Derek Brown, Stephanie Shao, Katherine A. McGlynn, Joel A. Nations, Corey A. Carter, Craig D. Shriver and Kangmin Zhu Cancer Epidemiol Biomarkers Prev June 1 2018 (27) (6) 673-679; DOI: 10.1158/1055-9965.EPI-17-0822 DISCLOSURES: no disclosure on file for Michel Chalhoub; No relevant relationships by Naureen Narula, source=Web Response No relevant relationships by Mohammed Salem, source=Web Response" @default.
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• W3092699699 date "2020-10-01" @default.
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• W3092699699 title "PRIMARY LUNG ADENOCARCINOMA: THE GREAT MASQUERADER" @default.
• W3092699699 doi "https://doi.org/10.1016/j.chest.2020.08.1360" @default.
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