Perplexing case of lung mass perfectly mimicking a malignancy

Area of Science:

• Pulmonology
• Rheumatology
• Oncology

Background:

• Presents a case of a 35-year-old male asthmatic with a history of smoking.
• The patient reported recurrent episodes of mild hemoptysis.

Observation:

• Physical examination revealed diminished breath sounds in the right infraclavicular area.
• Chest X-ray and CT scans identified a right upper lobe mass with nodules in other lobes.
• Video-assisted thoracoscopic surgery (VAT) showed a large, vascularized mass with surface nodules.

Findings:

• Histopathology suggested follicular bronchiolitis associated with connective tissue disease.
• Despite lacking overt symptoms, the patient tested positive for Rheumatoid Factor, ANA, anti-RO, and anti-CCP antibodies.
• Treatment with corticosteroids and azathioprine led to a 50% reduction in mass and nodule size and a decrease in ESR from 75 to 5 within six months.

Implications:

• Highlights the importance of considering autoimmune conditions in pulmonary presentations, even without typical symptoms.
• Demonstrates the efficacy of immunosuppressive therapy in managing lung manifestations of connective tissue disease.
• Suggests a potential link between autoimmune markers and the development of pulmonary nodules and masses.