The Journal of Association of Chest Physicians

CASE REPORT
Year
: 2021  |  Volume : 9  |  Issue : 1  |  Page : 37--40

Unusual presentation of adenocarcinoma of lung with metastasis in a young female


Harshil V Pandya, Hiren P Pandya 
 Swapn Multispeciality Hospital, Vastral, Ahmedabad, Gujarat, India

Correspondence Address:
Dr. Hiren P Pandya
Swapn Multispeciality Hospital, Shivsagar Complex, Mahadev Nagar Tekra, Vastral, Ahmedabad, 382418
India

Abstract

Adenocarcinoma of lung remains the commonest subtype of lung cancer. Despite of recent advances, the presentation of carcinoma of lung is delayed many of the times until later stages. Here is a case of a young pregnant female with adenocarcinoma of lung with brain metastasis with unusual presentation.



How to cite this article:
Pandya HV, Pandya HP. Unusual presentation of adenocarcinoma of lung with metastasis in a young female.J Assoc Chest Physicians 2021;9:37-40


How to cite this URL:
Pandya HV, Pandya HP. Unusual presentation of adenocarcinoma of lung with metastasis in a young female. J Assoc Chest Physicians [serial online] 2021 [cited 2021 Apr 20 ];9:37-40
Available from: https://www.jacpjournal.org/text.asp?2021/9/1/37/309473


Full Text



 INTRODUCTION



Lung cancer is the commonest cause of cancer-related deaths worldwide.[1] In India, lung cancer is the most common cancer in men and the fourth most common cancer in the overall population.[2] In both smokers and nonsmokers, adenocarcinoma is the most common histological subtype. Despite the recent advances, lung cancer remain undiagnosed until later stages. It is estimated that 40% of patients with newly diagnosed Non-small-cell lung carcinoma (NSCLC) have incurable stage IV disease.[3] Here is a case report of Adenocarcinoma of lung with unusual presentation.

 CASE REPORT



A 29 year old pregnant female with 34 weeks of gestation presented to OPD with complaints of severe headache with nausea since last 10 days, not subsiding with NSAIDS. There were no complaints of giddiness, fever, altered mental status, seizures or any weakness in any of the limbs. There were no similar episodes in past. Vitals were within normal limits. Neurological, Cardiac and Respiratory examinations were unremarkable. Patient was following regular check-up to gynaecologist during pregnancy.

MRI Brain with venography was done to rule out cerebral venous thrombosis. But to our surprise, it suggested well-circumscribed lesion in left frontal cortex with perilesional edema [Figure 1]. Possibility of metastasis was suggested rather than tuberculoma. MRI spectroscopy was done which showed similar findings but also showed two small nodular enhancing lesions, one in right occipital cortex and other in left inferior cerebellar hemisphere. All findings favouring the possibility of metastasis.{Figure 1}

Because it was critical to look for primary source of malignancy, patient was advised for X-ray chest (with abdominal shield) and USG breast. X-ray chest showed suspected lesion in left lower zone adjacent to heart border [Figure 2]. CT thorax was followed providing abdominal shield which revealed mass lesion in anterior basal segment of left lower lobe [Figure 3]. Bronchoscopy was done which revealed no intrabronchial lesion. So CT guided biopsy from mass was taken and sent for histopathology which revealed adenocarcinoma of lung [Figure 4].{Figure 2}{Figure 3}{Figure 4}

Elective Caesarean section was performed which delivered a healthy fetus. Following the delivery of fetus, patient was advised PET CT which showed no lesion elsewhere other than brain and lung. Palliative care has been provided from Radiotherapy and tissue has been sent for immune-histo chemistry (IHC) panel.

 DISCUSSION



The published literature on lung cancer in young adult population is scanty; the available studies are small, retrospective case series conducted in one medical institute.[4],[5],[6],[7],[8],[9]

Retrospective studies have confirmed the low rate of early stage disease detection in the young adult group.[6],[9],[10],[11] Lara et al.[12] (The California Registry) reported that 80% of their cohort of adults <50 years of age with NSCLC had advanced stage 3 or 4 disease. Late stage diagnosis could be attributed to the usual behaviour of young patient as well as consultants’ bias towards young adults. Young adult patients are less likely to consider cancer and thus they delay being seen by consultants. Similarly, the consultant may place cancer at the bottom of the differential and therefore may delay in evaluating the patient for possible presence of cancer. Hence, it is not unusual that younger patients are more likely to be asymptomatic at the time of presentation.[13],[14]

Adenocarcinoma accounts for 40% of all types of lung cancer. As seen in current case report of ours, more than 70% of patients are diagnosed in advanced stage (Stage IIIb and IV) where the disease is incurable and associated with poor outcomes.[15]

Historically, lung cancer has been found to be more prevalent in men than in women.[16],[17] Because the incidence of lung cancer in women has risen in recent past, there is increased concern with female lung cancer.[16],[18],[19],[20],[21] Compared with male counterparts, female patients with NSCLC have distinct clinical features.[16],[18],[19],[20],[21] The proportion of never smokers and adenocarcinomas is higher in females than males, result consisting with our case report.[20],[21]

Usually, patients with Lung cancer present with variety of symptoms. However, chest pain is definitively the most frequently reported symptom in younger patients according to comparative analysis.[22],[23] A large study from Korea showed that in most cases, lung cancer was detected with subjective symptoms, but 6.5% of cases had no symptoms indicative of lung cancer at the time of diagnosis.[24] Our patient presented with no symptoms suggestive of lung cancer, in fact patient was incidentally diagnosed to have Adenocarcinoma of lung.

At the time of diagnosis, approximately 50% of the cases of lung carcinoma have distant metastasis.[25] Although exact data are unavailable, the incidence of brain metastases in NSCLC patients is reportedly 24‑44% and it is considered to be increasing with the advances in diagnostic techniques, such as magnetic resonance imaging.[26] Although intention to do MRI in our patient was different, it must be said that our patient would have remained undiagnosed.

Financial Support and Sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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