Abstract Chronic beryllium disease (CBD) is a granulomatous lung disorder caused by beryllium exposure, often clinically and radiographically indistinguishable from sarcoidosis. While the carcinogenic potential of beryllium has been demonstrated in animal models and occupational cohorts, malignant transformation within established CBD remains exceedingly rare. We present the case of a 74-year-old lifetime non-smoker with extensive occupational beryllium exposure through helicopter refurbishing in military, NASA, and civilian roles. He presented with new-onset cough and wheezing. Chest imaging revealed two spiculated, calcified left upper lobe nodules. PET/CT showed hypermetabolic activity in both lesions without nodal or distant metastases. Navigational bronchoscopy with transbronchial biopsies demonstrated adenocarcinoma in the superior lingular segment (LB4) and necrotizing granulomatous inflammation in the apico-posterior segment (LB1). Fine-needle aspirations from mediastinal lymph nodes were negative for malignancy. Pulmonary function testing was normal. After multidisciplinary tumor board review, surgical resection was recommended. The patient underwent left upper lobectomy with mediastinal lymph node dissection. Final pathology revealed a 1.2 cm adenocarcinoma with a pure lepidic pattern (pTis pN0 cM0, Stage IA1) harboring an EGFR exon 19 deletion and PD-L1 expression of 1%. Necrotizing granulomas with focal calcifications were identified within the larger resected lesion, consistent with chronic beryllium disease. No adjuvant therapy was indicated per NCCN and VA guidelines. This case represents a rare instance of adenocarcinoma arising in the context of chronic beryllium-induced granulomatous inflammation. The coexistence of CBD and malignancy highlights the potential for chronic inflammatory and fibrotic injury to promote oncogenesis. Vigilant surveillance and continued occupational exposure assessment are essential in long-term management of beryllium-exposed patients. This abstract is funded by: None
Croteau et al. (Fri,) studied this question.