Computed tomographic diagnosis of bronchogenic carcinoma in HIV-infected patients
Introduction
Many authors have reported an increasing frequency of bronchogenic carcinoma in human immunodeficiency virus (HIV)-infected patients [1], [2], [3], [4], [5], [6]. These patients, who are usually younger than the general population with lung carcinoma, have a grim prognosis. Their poor outcome is probably related to the high proportion of patients in whom bronchogenic carcinoma (BC) is diagnosed at an advanced stage, ruling out surgical treatment. BC usually shows up as a peripheral or central mass or nodule on the chest radiograph, features resembling those of a number of opportunistic infections, and also those of lung cancer in the general population. To improve the outcome of these patients we need to obtain a positive diagnosis as early as possible. We describe our findings in 15 consecutive HIV-infected patients with lung cancer, based on plain radiographic and computed tomographic features. We also report the diagnostic value of transthoracic needle biopsy, and survival data.
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Patients and methods
We reviewed the medical charts (Table 1), plain radiographs and computed tomography (CT) scans of 15 HIV-infected patients in whom lung cancer was diagnosed between 1988 and 1994. All but one of the patients were men, and the mean age was 48 years (range 29–60 years). Six patients were homosexuals, four were intravenous drug users, two were infected by blood transfusion and one was infected after a cornea transplant operation. Two patients had no identified risk factor for HIV infection.
Results
Chest radiographic and CT findings are listed in Table 2. All the chest radiographs were abnormal, with parenchymal nodules or masses (n=11), hilar masses (n=3) and parenchymal air-space opacities (n=1). Pleural effusion was present in three patients. The main parenchymal lesion was located in an upper lobe in ten patients and in a lower lobe in five patients. There were 11 peripheral lesions and four central lesions.
The size range of the non-small-cell carcinomas on the CT scans was 20–80 mm
Discussion
Patients infected with HIV infection and AIDS are at an increased risk of opportunistic infections and malignancies such as Kaposi’s sarcoma and non-Hodgkin lymphomas. The increase in lung cancer among young HIV-infected patients has led some authors to speculate that the tumor may be associated with AIDS [3]. In a recent publication, Chan et al. [4] reviewed 261 cases of bronchogenic carcinoma during the pre-AIDS period and 232 cases during the AIDS era. Their results suggested that HIV
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