Images in Thorax

Pulmonary adenocarcinoma presenting as a giant pleural mass

K Kaira¹, A Takise¹, G Kobayashi¹, M Kamiyoshihara¹, M Mori²

¹ Maebashi Red Cross Hospital, Gunma, Japan
² First Department of Internal Medicine, Gunma University, Gunma, Japan

Correspondence to:
Correspondence to:
Dr K Kaira
Maebashi Red Cross Hospital, Department of Respiratory Medicine, 3-21-36 Asahi-cho, Maebashi, Gunma 377-0014, Japan; k-kaira{at}maebashi.jrc.or.jp

Keywords: lung cancer; giant pleural mass

A 57 year old female non-smoker with no asbestos exposure was admitted with right chest pain and fever. Magnetic resonance imaging revealed a huge mass occupying the right hemithorax (fig 1). She underwent right posterolateral thoractomy following a negative bronchoscopic examination with transbronchial lung biopsy and transthoracic needle biopsy. A giant, well circumscribed, lobulated solitary tumour 13 cm in diameter attached with a pedicle to the visceral pleura was surgically removed (fig 2A). Macroscopically, the tumour was nearly protruding into the pleural space, compressing the right lower lobe upwards and presenting as a pleural mass. Histological examination showed poorly differentiated adenocarcinoma of the lung (fig 2B). A CT scan performed 12 months after surgery showed a well defined homogeneous mass abutting the pleura in the right lung. The most likely diagnosis was a local relapse of adenocarcinoma of the lung. She was treated with platinum-based chemotherapy and docetaxel and gefinitib. With no evidence of distant metastasis and no efficacy of chemotherapy, right lateral thoracotomy was performed. Pathological examination showed a recurrence of adenocarcinoma of the lung. The patient remains healthy 36 months after the initial diagnosis.

View larger version (93K): [in this window] [in a new window]   Figure 1  (A) T1-weighted coronal and (B) sagittal MR images showing a heterogeneous mass in the right lower hemithorax (curved arrows) associated with compression and displacement of the right lower lobe (straight arrow) and right hemidiaphragm.

 

View larger version (108K): [in this window] [in a new window]   Figure 2  (A) Gross pathological specimen showing a yellowish encapsulated mass attached with a pedicle to the visceral pleura (arrow). (B) Histological section showing poorly differentiated adenocarcinoma.

 

Pulmonary adenocarcinoma with a localised extrapulmonary growth pattern presenting as a localised pleural tumour has not previously been described. Primary lung cancer mimicking pleural neoplasm—"pseudomesotheliomatous carcinoma"—is considered to represent a type of peripheral lung adenocarcinoma with a distinctive diffuse growth pattern.¹ The clinical similarities between the present case and pseudomesotheliomatous carcinoma are the marked extrapulmonary growth and the presence of a small subpleural nodule. Although the pattern of recurrence also showed a localised pleural mass, surgery for metastases can improve survival.

1. Harwood TR, Gracey DR, Yokoo H. Pseudomesotheliomatous carcinoma of the lung: a variant of peripheral lung cancer. Am J Clin Pathol 1976;65:159–67.[Medline]

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