Subject(s)
Hamartoma/diagnostic imaging , Incidental Findings , Lung Diseases/diagnostic imaging , Adult , Bronchoscopy/methods , Follow-Up Studies , Hamartoma/pathology , Humans , Lung Diseases/pathology , Male , Radiography, Thoracic/methods , Severity of Illness Index , Tomography, X-Ray Computed/methodsABSTRACT
We describe a 45-year-old man, heavy smoker, presenting with 6.5 x 5.3 cm painless solitary growth over right temporal region. Chest radiograph showed opacity over left lung abutting mediastinum. Computed tomogram revealed homogenous ill-defined opacity indicative of bronchogenic carcinoma with metastases to right lung, liver and adrenal glands. The carina was involved with tumor along with partial obliteration of the left main bronchus over bronchoscopy; the biopsy confirmed squamous cell carcinoma. The biopsy from scalp lesion and cervical lymph node also established metastatic squamous cell carcinoma. Although cutaneous metastasis with primary lung cancer has been reported, the scalp lesion as a sole presenting feature of underlying quiescent squamous cell lung cancer, which is described here, has not been reported frequently.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Lung Neoplasms/diagnosis , Scalp/pathology , Skin Neoplasms/secondary , Biopsy , Carcinoma, Squamous Cell/pathology , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Skin Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
A 55-year-male with chest symptoms and apical pulmonary lesions was diagnosed as a case of sputum smear-negative pulmonary tuberculosis at a peripheral health centre in India on the basis of Revised National Tuberculosis Control Programme Guidelines--he was put on antitubercular chemotherapy. He had no radiological or clinical improvement with antitubercular treatment, so the patient was referred to our institute. On evaluation, we found that the patient had multisystem involvement with typical features of Marfan syndrome and a suggestive history in other blood-relatives. Upper lobe fibrosis, bronchiectasis, emphysematous changes, multiple blebs, small pneumothorax, pleural fibrosis and pleural thickening were seen which were due to Marfan syndrome rather than tuberculosis. The present case seems to signify the search for alternative aetiologies in similar clinico-radiological presentations if, after 3 months, cultures for Mycobacterium are still negative (despite sputum induction and/or bronchoscopy with biopsies) and the patient is having no radiological improvement.
