World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website http://www.wjon.org

Case Report

Volume 9, Number 4, August 2018, pages 110-114

Adenocarcinoma of Lung and Bronchial Carcinoid Presenting as Double Synchronous Primary Lung Cancer: A Case Report and Review of Literature

Figures

Figure 1.
Figure 1. Chest X-ray showing complete right hemithorax opacification with mediastinal shift to the left.
Figure 2.
Figure 2. (a) Coronal view CT chest showing massive right pleural effusion with atelectasis of right lung and mediastinal shift to the left. (b) Sagittal view of CT chest showing massive right pleural effusion with atelectasis of right lung and mediastinal shift to the left.
Figure 3.
Figure 3. Fiberoptic bronchoscopy revealed an endobronchial lesion in left lower bronchus.
Figure 4.
Figure 4. (a) Endobronchial biopsy: carcinoid tumor, high power of organoid pattern with uniform nuclei and no mitosis or necrosis (H&E, magnification × 400). (b) Carcinoid tumor: the tumor cells are immunoreactive to neuroendocrine marker chromogranin (magnification × 400).
Figure 5.
Figure 5. (a) Pleural mass biopsy on high magnification showing acinar pattern of adenocarcinoma composed of glands lined by malignant cells. Some cells show cytoplasmic vacuoles (H&E, magnification × 400). (b) Pleural mass biopsy: the malignant cells are strongly positive for immunomarker cytokeratin -7, which supports the diagnosis of lung primary (magnification × 400).

Table

Table 1. Laboratory Parameters
 
Pleural fluid analysis
  AppearanceCloudy
  WBC count184 (76% lymphocytes)
  RBC count5,035,000
  Lactate dehydrogenase534
  Protein5.1
  Glucose273
  Adenosine deaminase20
  Mycobacterium tuberculosis PCRNegative
  Aerobic cultureNegative
  AFB cultureNegative
Sputum AFB × 3Negative
Connective tissue disease workup
  Antinuclear, anti DNA, anti JO-1, anti GBM, anti CCP, anti Scl-70, anti Sm, anti RNP antibodies, rheumatoid factor, ANCA vasculitidesNegative
HIV antibodyNegative
QuantiFERON-TBIndeterminate