AB054. A case of cryptogenic organizing pneumonia—is one biopsy enough?

Abstract: To describe a case of lung squamous cell carcinoma with initial lung biopsy of organizing pneumonia. A 78-year-old man, former smoker, with a history of type II diabetes and hypertension, was referred to our department a year ago with symptoms of dry cough and right pleuritic pain for the past 4 months and abnormal findings in imaging despite antibiotic treatment. The CT-scan of the thorax revealed consolidation with a cavity in the right middle lobe. Bronchoscopy was unrevealing. CT-guided fine-needle-biopsy of the lesion had findings consistent with cryptogenic organizing pneumonia. As he was clinically stable, a wait-and-watch policy was opted. Three months later, however, a new lesion developed in the left lung. Oral corticosteroid regimen was administered which resulted in marked improvement of the lesion on the left whereas the right lesion was somewhat larger. The patient was subjected to an open lung biopsy. Upper right lobectomy, excision of part of the lower right lobe as well as thoracic lymph node dissection was performed. Histopathology report was consistent with the diagnosis of poorly differentiated squamous cell carcinoma. After taking under consideration staging (T3N2M0) and age the patient will receive adjuvant radiotherapy. The finding of intra alveolar polyps of granular tissue with surrounding inflammatory infiltrate is a nonspecific acute lung injury reaction, that can be either found alone, in the cases of organizing pneumonia, or it can accompany a variety of other, specific lung lesions. Special attention is needed before one can reach a diagnosis of organizing pneumonia from a small piece of tissue. In the case presented, special problems arose because the lesions behaved like an organizing pneumonia (appearance of new lesions-partial response to corticosteroids). In recent years there have been a few case reports of adenocarcinomas surrounded histologically by a large rim of tissue (20% of the lesion) with features of organizing pneumonia.

Keywords: Imaging findings; open lung biopsy; squamous