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Bronchial cast hiding a lung cancer
Marcello Migliore1, Nicola Ciancio, Riccardo Giuliano
1Thoracic Surgery, University of Catania, Catania, Italy. mmiglior@unict.it.
Multidisciplinary Respiratory Medicine
|November 15, 2012
Summary
A rare case revealed a bronchial cast obstructing a patient's airway, unexpectedly containing lung cancer. This finding suggests a potential, previously unreported link between bronchial casts and lung malignancy.
Area of Science:
- Pulmonology
- Oncology
- Pathology
Background:
- Bronchial casts (BC) are typically associated with benign airway conditions.
- The formation of BCs involves mucus, fibrin, and inflammatory cells.
- Previous associations have been documented with benign tracheobronchial tumors.
Observation:
- A 70-year-old male presented with severe hypoxia, hemoptysis, and cough.
- Imaging revealed right lower lobe collapse, confirmed by bronchoscopy to be due to mucus occlusion.
- Bronchial aspiration identified a bronchial cast and a stenotic, inflamed right lower lobe bronchus.
Findings:
- Histopathology of the bronchial cast revealed fibrin, lymphocytes, and neutrophils.
- Unexpectedly, lung cancer cells were also identified within the bronchial cast.
- The right lower lobe bronchus orifice showed inflammation and stenosis.
Implications:
- This is the first reported instance of lung cancer associated with a bronchial cast.
- The relationship between bronchial casts and lung cancer (causal or incidental) requires further investigation.
- This case highlights the importance of thorough histopathological examination of bronchial casts.
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