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Nódulos pulmonares con calcificación explosiva finalmente diagnosticados como adenocarcinoma de pulmón: reporte de un
Zhen Li1, Min Song, Mingzhen Zhu
1Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China.
Rationale:
Pulmonary nodules are a common lung condition, and accurately determining their nature is crucial for doctors to develop appropriate treatment plans. Early identification of malignant nodules can improve patient survival rates. Therefore, accurately distinguishing between benign and malignant pulmonary nodules is essential for optimizing patient management and enhancing the efficiency of healthcare resource utilization.
Patient Concerns:
The patient is a 53-year-old male. During a routine health examination, a calcified pulmonary nodule was identified. Initially, the nodule was considered benign due to its characteristic calcification and stable appearance on imaging. Over an 8-month follow-up period, serial imaging studies demonstrated no significant changes in the size or morphology of the nodule. Despite the absence of progression, the patient expressed concern regarding the possibility of lung cancer, prompting further diagnostic evaluation.
Diagnoses:
Contrast-enhanced computed tomography scan revealed a mass-like high-density shadow in the anterior segment of the left upper lobe, with clear margins, measuring approximately 16 mm × 14 mm × 13 mm. The lesion is adjacent to the trachea and exhibits lobulation, spiculation, and pleural retraction. Calcification is present within the lesion, and blood vessels are seen entering it. The enhanced scan showed mild enhancement. Multiple nodules were observed near the pleura of the left lower lobe. All lung cancer-related tumor markers were negative. The patient underwent a thoracoscopic partial lobectomy (left upper and lower lobes) and thoracoscopic lymph node dissection. Postoperative pathology confirmed invasive lung adenocarcinoma with intrapulmonary metastasis.
Interventions:
The patient underwent surgical treatment, followed by genetic testing, which revealed anaplastic lymphoma kinase and AKT serine/threonine kinase 1 mutations. The patient is now receiving targeted therapy with ensartinib.
Outcomes:
The patient was discharged 7 days post-surgery and is now on ensartinib for targeted therapy, with regular follow-up examinations scheduled.
Lessons:
This case emphasizes that nodules with diffuse, popcorn-like calcification do not rule out the possibility of lung cancer. A comprehensive evaluation integrating multidimensional imaging features is necessary. For nodules with conflicting imaging characteristics, minimally invasive surgical resection remains valuable for diagnosis. This approach broadens our diagnostic perspective on calcified nodules, enhances clinicians' understanding of lung adenocarcinoma, and reduces the rate of misdiagnosis.
