kpmle2
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A 67-year-old woman is seen in the doctor’s office
for severe left leg pain, worse with standing
and walking, starting insidiously 3 weeks
ago. There has been no trauma to the area.
The patient also notes that over the past 6
months, the tips of her fingers have become increasingly
thick, she has lost 2.3 kg (5 lb) unintentionally,
and she has been suffering from a
persistent, nonproductive cough. She has a 60-
pack-year smoking history and continues to
smoke two packs per day. Her temperature is
36.7°C (98.1°F), blood pressure is 132/81 mm
Hg, pulse is 75/min and regular, and respiratory
rate is 15/min. Physical examination is significant
for clubbed fingers and pain on palpation
of the distal left tibia. X-ray film of the
chest shows a focal 5-cm mass lesion in the left
lower lung that is highly suspicious for bronchogenic
carcinoma. A bronchoscopy with
biopsy is pending. Based on the patient’s presentation,
which of the following is the most
likely histologic type of lung cancer present in
this patient?
(A) Adenocarcinoma
(B) Bronchoalveolar cell carcinoma
(C) Large cell carcinoma
(D) Small cell carcinoma
(E) Squamous cell carcinoma
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| charlottenian
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A?
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| nightflight1945
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(A) Adenocarcinoma
A Case of Hypertrophic osteodystrophy in the context of lung cancer ,
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| docnit
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hmm
can u pls explain how would bronchoalveloar and large cell carcinoma present?
and in this scenario its mentioned the lady is a heavy smoker, adenocarcinoma is usually associated in non smokers getting lung cancer.
small cell and squamous cell which are both centrally located tumours are associated heavily with smoking and adenocarcinoma is peripherally located tumour.
i was just wondering how do bronchoalveloar and large cell present clinically?
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| docnit
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does the bronchoalveloar present with wt loss, wheezing ???? as its affecting the bronchiloes and the alveoli??
is it associated with smoking? and is it central/peripheral?
and never heard about a case presentation of the rare large cell ca..
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| docnit
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nd isnt pulmonary hypertrophic osteodystrophy assocaited with brronchogenic carcinoma which means any of them?? or is it only adenocarcinoma?
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| ngaybinhyen
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Hypertrophic osteoarthropathy: clubbing of the fingers & toes, periostitis of long bones (distal tibia, femur, and radius), and arthritis.
1. primary (hereditary)
2. secondary
- non–small cell lung cancer: 80-90%
- Other causes: other neoplasms (mesothelioma), chronic pulmonary infections, congenital heart disease, cirrhosis, HIV infection, IBD
*** It occurs in up to 10% of patients with adenocarcinoma
*** Non-small cell lung cancer includes Squamous cell carcinoma, adenocarcinoma, and large-cell or undifferentiated carcinoma
Edited by ngaybinhyen on 10/01/08 - 01:36 PM
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| kpmle2
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The correct answer is A.
Patients with a history
of cough, unintentional weight loss, and
significant smoking history should be worked
up for lung cancer. Adenocarcinoma is the
most common lung cancer, occurring most often
peripherally. Hypertrophic pulmonary osteoarthropathy
(HPOA) is common and is
characterized by the proliferation of soft and
osseous tissue at the distal portions of extremities.
Among lung cancer patients, hypertrophic
pulmonary osteoarthropathy is most frequently
associated with adenocarcinoma and least frequently
with small cell carcinoma. HPOA typically
presents with digital clubbing, periostosis
of long bones, and synovial effusions of the
larger joints. Periostosis is often accompanied
by pain on palpation of the affected area.
When HPOA is suspected, the chest should be
examined closely because lung neoplasm is
the most frequent cause of acute HPOA.
Answer B is incorrect. Bronchoalveolar type
of adenocarcinoma is associated with multiple
nodules, interstitial infiltration, and prolific
sputum production. Its appearance on x-ray of
the chest mimics interstitial pneumonia. It is
less predictably associated with digital clubbing
or hypertrophic pulmonary osteoarthropathy.
Answer C is incorrect. Large cell carcinoma
is a relatively uncommon form of bronchogenic
carcinoma that may produce β-human
chorionic gonadotropin (β-hCG), resulting in
gynecomastia, milky nipple discharge, and elevated
serum concentrations of plasma β-hCG.
Answer D is incorrect. Small cell carcinoma
is strongly related to cigarette exposure and associated
with Cushing’s syndrome, syndrome
of inappropriate antidiuretic hormone, peripheral
neuropathy, subacute cerebellar degeneration,
and Eaton-Lambert syndrome. Small cell
carcinoma has the worst prognosis of the bronchogenic
carcinomas and has metastasized at
time of diagnosis in two-thirds of patients.
Answer E is incorrect. Squamous cell carcinoma
is most often located centrally and associated
with hypercalcemia via production of
parathyroid hormone-related peptide. It is also
associated with pathologic fractures and kidney
stones.
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| nightflight1945
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The most common form of lung cancer associated with Hypertrophic Osteodystrophy is Adenocarcinoma,
docnit you've ignored this point in the question , it is the point
Good Q!
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| ngaybinhyen
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Good Q and discussion
Many thanks, guys
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| docnit
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nightflight i didnt ignore that point, i didnt know that adenocarcinoma is most commonly associated with hypertrophic osteoarthropathy so i had all those doubts...
"and isnt pulmonary hypertrophic osteodystrophy associated with bronchogenic carcinoma which means any of them?? or is it only adenocarcinoma?"
Thanks for clearing it! 
good q and discussion !
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