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• W4387248639 abstract "SESSION TITLE: Lung Cancer Case Report Posters 9 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Mucinous adenocarcinoma (MAC) of the lung is a rare subtype of non-small cell lung cancer (NSCLC) that presents with a wide range of clinical and radiological features. We report a case of MAC with acinar predominant growth pattern presenting as rapidly progressive hypoxic respiratory failure. CASE PRESENTATION: A 61-year-old female with a history of hypertension, deep vein thrombosis/pulmonary embolism, and hyperlipidemia presented to the hospital with progressively worsening shortness of breath and cough with copious secretions over one month. On admission, the patient was hypoxic and required 2 liters of oxygen. Chest radiography showed bilateral progressive airspace disease and chest CT scan revealed bilateral consolidations and ground glass opacities.Initial lab work on admission was unremarkable, and the patient was started on antibiotics. Infectious disease was consulted and recommended fungal serology, sputum culture, and ANA/ANCA. ANA/ANCA turned negative. The patient's respiratory status continued to worsen rapidly, prompting pulmonary consult, and the patient underwent bronchoscopy with BAL and trans bronchial biopsy. Bronchoscopy showed diffuse numerous foamy secretions throughout the lungs, and the BAL return was milky and foamy, suggestive of pulmonary alveolar proteinosis (PAP). The patient was transferred to the ICU intubated and placed on high dose steroids and broad-spectrum antibiotics.All the cultures from the BAL were negative, and anti-GM-CSF antibodies and PAS stain on BAL and tissue were negative, ruling out PAP. The tissue biopsy came back after transfer, showing clusters of epithelial proliferation forming complex glandular structures with atypia, suggesting adenocarcinoma with a predominant acinar growth pattern. The lesional cells were positive for TTF-1 and negative for p40. The patient was started on urgent chemotherapy but unfortunately died due to rapidly progressive refractory respiratory failure. DISCUSSION: This case highlights the challenges in diagnosing and managing patients with respiratory distress. Despite a thorough evaluation, including imaging, infectious disease consultation, and bronchoscopy, the initial diagnosis of pneumonia and PAP was incorrect, and the patient's condition continued to deteriorate. The subsequent diagnosis of adenocarcinoma with a predominant acinar growth pattern was unexpected and underscores the importance of considering a broad differential diagnosis in patients with respiratory symptoms, even in the absence of traditional risk factors. The patient's clinical course was rapidly progressive, and despite urgent chemotherapy, she died due to refractory respiratory failure. CONCLUSIONS: In conclusion, this rare case highlights the importance of considering malignant etiologies in patients presenting with refractory and rapidly progressive respiratory failure, even in the absence of a history of smoking or other risk factors and the need for a comprehensive diagnostic evaluation in the presence of progressive respiratory symptoms. Timely diagnosis and management of pulmonary malignancies may improve patient outcomes and reduce morbidity and mortality associated with refractory respiratory failure. Further studies are necessary to determine optimal treatment strategies for adenocarcinoma with predominant acinar growth pattern presenting with diffuse foamy secretions throughout the lungs. REFERENCE #1: Ghalib S, Itty R, Parimi SA, Abdelwahab H, Saha BK, Beegle S. A 52-Year-Old Man Who Smokes With Rapidly Progressive Respiratory Failure. Chest. 2023 Mar;163(3):e119-e123. doi: 10.1016/j.chest.2022.10.006. PMID: 36894266. REFERENCE #2: Yokouchi H, Murata K, Murakami M, et al. [A case of diffuse pneumonictype of mucinous adenocarcinoma treated with reduction surgery]. GanTo Kagaku Ryoho. 2012;39(12):2396-2398 DISCLOSURES: No relevant relationships by Derek Anderson No relevant relationships by Mitch Keena No relevant relationships by Dre Steinwehr No relevant relationships by Hallie Thompson" @default.
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• W4387248639 date "2023-10-01" @default.
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• W4387248639 title "A RARE CASE OF MUCINOUS ADENOCARCINOMA (MAC) OF THE LUNG PRESENTING AS RAPIDLY PROGRESSIVE HYPOXIC RESPIRATORY FAILURE" @default.
• W4387248639 doi "https://doi.org/10.1016/j.chest.2023.07.2846" @default.
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