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Pulmonary infections mimicking cancer: a retrospective, three-year review
K V Rolston1, S Rodriguez, N Dholakia
1Department of Medical Specialties, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA.
Abstract:
Pulmonary infections can mimic or occasionally co-exist with pulmonary neoplasms. In order to determine the frequency and nature of these infections, we conducted a retrospective analysis, covering a 3-year period, of patients who were referred to our center with presumed lung cancer but turned out to have pulmonary infection instead. The overwhelming majority of patients (93.3%) referred to "rule out" lung cancer were documented as having a neoplastic process, and only 1.3% had an infection. Fungal infections (histoplasmosis, cryptococcosis, coccidiomycosis) accounted for 46%, mycobacteria for 27%, bacteria for 22%, and parasitic lesions (dirofilariasis) for 5% of these infections. The most common clinical manifestations were cough and chest pain, and the most common radiographic finding was a solitary pulmonary nodule. There were no specific clinical or radiographic features predictive of either infection or neoplastic disease. All patients responded to specific anti-infective therapy with or without surgical excision. Our data indicate that pulmonary infections mimic neoplasms very infrequently. However, establishing a specific diagnosis is critical, since the management and outcome of these two processes are entirely different.
Insights
Pulmonary infections rarely mimic lung cancer, with only 1.3% of patients referred for suspected cancer actually having an infection. Prompt diagnosis is crucial for effective treatment of these distinct conditions.
Area of Science:
- Pulmonology
- Infectious Diseases
- Oncology
Background:
- Pulmonary infections and neoplasms can present with similar symptoms.
- Differentiating between these conditions is clinically significant due to differing management and prognoses.
Purpose of the Study:
- To determine the frequency and characteristics of pulmonary infections in patients initially suspected of having lung cancer.
- To assess the diagnostic challenges and clinical features differentiating infection from neoplasm.
Main Methods:
- Retrospective analysis of patients referred for presumed lung cancer over a 3-year period.
- Review of clinical, radiographic, and pathological data to identify diagnoses of infection versus neoplasm.
Main Results:
- Only 1.3% of patients referred for suspected lung cancer were diagnosed with pulmonary infection.
- Fungal infections (46%), mycobacteria (27%), bacteria (22%), and parasitic infections (5%) were identified.
- Common symptoms included cough and chest pain; solitary pulmonary nodules were frequent radiographic findings.
- No specific clinical or radiographic features reliably distinguished infection from neoplasm.
Conclusions:
- Pulmonary infections infrequently mimic neoplastic disease.
- Accurate diagnosis is essential for appropriate patient management and improved outcomes.
- Specific anti-infective therapy, with or without surgery, was effective in all infection cases.