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Aim: To report unusual clinical and radiological presentation of adenocarcinoma in a healthy female.Background: Adenocarcinoma is the most common subtype in nonsmokers.The radiological presentation may range from solitary nodules to large masses and multilobar consolidations.In the present case, radiological presentation mimicked miliary tuberculosis but it turned out to be lepidic adenocarcinoma on further evaluation.Lepidic adenocarcinoma is characterized by the proliferation of tumor cells along the lines of alveolar walls with or without evidence of stromal, vascular, and pleural invasion.Case description: A 60-year-old female patient with no known comorbidities presented to the outpatient department with nonspecific complaints of mild chest and abdominal discomfort and uneasiness.Chest X-ray showed diffuse multiple numerous randomly distributed sharply marginated nodules in bilateral lung parenchyma suggesting the possibility of miliary nodules, and small air space consolidation in both upper lobes.Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy was performed.Investigations for Tuberculosis, Fungal, and Bacterial infections were negative.Transbronchial lung biopsy histopathology and immunohistochemistry (IHC) Napsin A and cytokeratin 7 (CK-7) revealed features suggestive of primary minimally invasive adenocarcinoma lung -lepidic type.The patient was referred to the medical oncology department.Conclusion: Adenocarcinoma lung is the most common subtype of non-small lung cancer.Clinical and radiological presentation can mimic other infective or nonmalignant diseases.A high index of suspicion and further evaluation is required in concerned patients to identify it at the earliest.
Chandra et al. (Wed,) studied this question.