CRA33 CASE OF PRIMARY INVASIVE MUCINOUS LUNG ADENOCARCINOMA

Boon Tung Low1, Guan Yee Lau1, Siew Teck Tie2
1.Internal Medicine Department, Hospital Miri, Miri, Sarawak, Malaysia
2.Divisions of Respiratory Medicine, Department of Medicine, Sarawak General Hospital. Kuching, Sarawak, Malaysia

This is a case of middle age gentleman who presented with cough, fever and pleuritic chest pain associated with loss of weight and appetite initially treated as pneumonia. Chest X-ray showed mid-zone consolidation and it persists after 1 months post treatment. Contrast enhanced Computed Tomography Scan of the thorax showed focal right lung consolidation with hilar lymphadenopathy. Transbronchial cryobiopsy over the RB6 was done 6 months later as the consolidation increases and patient finally agree for invasive intervention. The histopathology examination revealed invasive mucinous adenocarcinoma and immunohistochemistry expresssion showed CK7 (diffuse), CK20 (focal) and CDX2 (focal) and no TTF1 detected. CT Abdomen and pelvis did not reveal any evidence of malignancy. Oesophagogastroduodenoscopy and colonoscopy did not show any evidence of malignancy. Resection of lung was planned for this gentleman after multidisciplinary discussion among the pulmonologist, oncologist and cardiothoracic surgeon. Primary invasive mucinous adenocarcinoma previously known as mucinous bronchioalveolar carcinoma accounted about 0.2% of the primary lung malignancy and about 3-10% of the adenocarcinoma of lung. In view scarcity of the prevalence of invasive mucinous adenocarcinoma of the lung, the prognosis is yet to ascertained.  The presentation and radiological imaging often mimics pneumonia hence high clinical suspicion is required in order to get the diagnosis as soon as possible. Chest X-ray often reveal consolidation predominantly located at lower zone and CT scan often can reveal consolidation along with sub-solid or solid nodules. Rarely CT can reveal large thin walled cysts. Treatment is similar with other other adenocarcinoma and surgical resection might be helpful in early stage of disease.