CRA38 LUNG ADENOCARCINOMA DIAGNOSED BY BRONCHOALVEOLAR LAVAGE CELL BLOCK

Jae Lim C. K.1, Nor Safiqah Sharil2, Nik Nuratiqah Nik Abeed1, Boon Hau Ng1, Andrea BanYu-Lin1
1 Faculty of Medicine, University Kebangsaan Malaysia, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
2 Faculty of Medicine, University Sains Islam Malaysia, Negeri Sembilan, Malaysia.

Case report

Lung adenocarcinoma, a common subtype of non-small cell lung cancer, often presents diagnostic challenges, particularly in elderly or frail patients where traditional biopsy methods may pose significant risks. This case report illustrates the use of bronchoalveolar lavage (BAL) cell block as an effective diagnostic tool in such a scenario. A 73-year-old elderly woman presented with chronic cough for 3 months with worsening breathlessness over one week. Initial chest X-ray revealed left hydropneumothorax. A small bore chest tube was inserted using the Seldinger technique. Analysis of pleural fluid showed a lymphocytic exudate but was negative for malignancy and tuberculosis. Computed tomography guided lung biopsy was inconclusive. The BAL cell-block analysis confirmed the diagnosis of lung adenocarcinoma, with immunohistochemical staining positive for CK7 and Napsin A and genetic analysis revealing an EGFR mutation (Exon 19 deletion). The patient was initiated on Gefitinib, a targeted EGFR inhibitor. At a one-month follow-up, there was no recurrence of pleural effusion, and the patient's symptoms had improved. The BAL cell block is a valuable diagnostic tool in the identification of lung adenocarcinoma, especially in high-risk patients. This method should always be attempted when conventional biopsy techniques are not feasible or inconclusive, facilitating early and accurate diagnosis and treatment.