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• W4387248821 abstract "SESSION TITLE: Lung Cancer Case Report Posters 4 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Invasive Mucinous Adenocarcinoma (ADC) (IMA) is a rare subtype of ADC with an incidence of 2-5%. Little is known of the manifestation and prognosis of IMA, although a 2015 study suggested disease-free-survival between low-grade nonmucinous ADC and intermediate-grade nonmucinous ADC (1). We present a rare case of IMA that illustrates the possible manifestations and diagnostic work-up. CASE PRESENTATION: A 48 year old male, current smoker with recently resolved left-chest shingles had multiple ED visits for persistent left-sided chest pain and dyspnea. He moved to New York from Venezuela 4 months prior. History was pertinent for lead exposure at work and type B symptoms. Computed tomography (CT) revealed large left pleural effusion and a 7mm right lung base nodule. Thoracentesis yielded 1.2L serosanguinous fluid found to be a lymphocytic exudate. Cytology returned negative. Repeat cytology via pigtail was also unrevealing. Adenosine deaminase was inconsistent with tuberculosis. After 1 week, CT revealed rapid loculation of effusion. Lytic therapy with tPA/DNase and antibiotics were administered. Due to progression of loculations, lung decortication with pleural biopsy was performed. Surgical pathology revealed moderately differentiated ADC with goblet and signet ring cell features, staining positive for CK7 and mucicarmine. Morphology and immuno-profile was nonspecific for any origin. Genetic analysis shows KRAS and STK11 mutations. No obvious primary tumors were identified on imaging, but new parenchymal and pleural nodules were revealed. Diagnosis of IMA with signet ring features was made and carboplatin and pemetrexed were initiated. DISCUSSION: The World Health Organization (WHO) classified IMA as a rare variant of invasive ADCs in 2021 (2). It was reclassified and separated from other mucin producing ADCs in 2015 due to prognostic differences. Whereas other subtypes may produce mucin, IMA is more aggressive compared to ADC in situ, known to have a 100% 5-year disease-free-survival rate post resection (1). Histology demonstrates goblet or columnar cells with abundant intracellular mucin and spreads in a lepidic pattern, further emphasizing differentiation from other ADC subtypes. Most IMAs have a solid pattern, but 20% have a pneumonic pattern presenting as consolidation, ground glass opacities, crazy paving and air bronchograms. Location is usually in lower lobes and may be misidentified as pneumonia. Pleural effusion as an early presentation is rare. Our patient presented with pleural effusion and pleural and parenchymal nodules. The pleural effusion rapidly loculated within 1 week, which is unusual behavior for malignant effusions and is more characteristic of infectious inflammatory etiology such as empyema. Metastatic study via CT head and abdomen found no obvious primary malignancy. CONCLUSIONS: We describe a rare case of a 48 year old male with IMA involving the pleura with signet ring features and no other obvious primary sites. The manifestation of IMA as a rapidly loculating pleural effusion has not yet been reported in literature to the best of our knowledge. REFERENCE #1: Lee HY, Cha MJ, Lee KS, Lee HY, Kwon OJ, Choi JY, Kim HK, Choi YS, Kim J, Shim YM. Prognosis in Resected Invasive Mucinous Adenocarcinomas of the Lung: Related Factors and Comparison with Resected Non Mucinous Adenocarcinomas. J Thorac Oncol. 2016 Jul;11(7):1064-73. doi: 10.1016/j.jtho.2016.03.011. Epub 2016 Mar 22. PMID: 27016260. REFERENCE #2: Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011 Feb;6(2):244-85. doi: 10.1097/JTO.0b013e318206a221. PMID: 21252716; PMCID: PMC4513953 DISCLOSURES: No relevant relationships by Rowena D'Souza No relevant relationships by Fabiano Das Gracas No relevant relationships by Khalid Gafoor No relevant relationships by Holman Li No relevant relationships by Aisha Mujahid No relevant relationships by Faria Nitol" @default.
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• W4387248821 date "2023-10-01" @default.
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• W4387248821 title "A RARE PLEURAL MODERATELY DIFFERENTIATED ADENOCARCINOMA WITH GOBLET/SIGNET RING CELL FEATURES AND LOCULATED PLEURAL EFFUSIONS" @default.
• W4387248821 doi "https://doi.org/10.1016/j.chest.2023.07.2920" @default.
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