Adenocarcinoma of the Lung in a 50-Year-Old Woman

During the past few months, a 50-year-old woman had experienced cough, dyspnea, mild hemoptysis, and a 30-lb weight loss. She had no fever, chills, or rigors. The patient had smoked cigarettes for 30 years.

Drs I. Hitti, Raj K. Jain, and Arunabh of Forest Hills, NY, report that the chest film demonstrated a left hilar mass with a collapsed left upper lobe (A). A bronchoscopy with a biopsy of the lesion and a transbronchial needle aspiration confirmed adenocarcinoma of the left upper lobe with left hilar lymph node metastases.

Histopathologic examination of the biopsy specimen showed glandular differentiation and possibly mucus production by the tumor (B). Adenocarcinoma of the lung spreads via the lymphatic system; metastases were present in the nodes of this patient (C). Specimens showed anthracotic pigment, which is frequently seen in lung biopsy specimens of long-term cigarette smokers. Ninety percent of patients who have lung cancer are current or former smokers.¹

The 2 major types of cancer that originate in the lungs are classified according to their histologic appearance: non–small cell and small cell. The non–small cell cancers are squamous cell carcinoma; large cell, or large cell anaplastic, carcinoma; and adenocarcinoma, which includes bronchoalveolar cancer. Adenocarcinoma is the most frequently occurring lung cancer in the United States.²

This patient underwent radiotherapy and chemotherapy. She responded well to treatment but died 8 months later of systemic, metastatic-related problems.

REFERENCES:1. Wingo PA, Ries LA, Giovino GA, et al. Annual report to the nation on the status of cancer, 1973-1996, with a special section on lung cancer and tobacco smoking. J Natl Cancer Inst. 1991;91:675-690.
2. el-Torky M, el-Zeky F, Hall JC. Significant changes in the distribution of histologic types of lung cancer. A review of 4928 cases. Cancer. 1990;65:2361-2367.