Lung Cancer: Bronchoalveolar Carcinoma
A 56 year old caucasian male was taken to the emergency room with acute hypertension in May,1997. Chest X-ray revealed opacity in the right upper lung. CT chest scan revealed mass in the right apical region with some abutment to the pleural margin. Needle biopsy revealed bronchioloalveolar carcinoma.
The final pathology report from thoracotomy 5/25/97 describes bronchioloalveolar carcinoma of the right upper lobe tumor extending to, but not through, the pleural surface. There was tumor present in peribronchial vessels and paravascular tissue at the surgical margin. There was involvement of lymphatic vessels by tumor and microscopic tumor in four lymph nodes examined. Patient received adjuvant radiotherapy after surgery, but he developed a regional relapse in the neck and chest wall. Patient initiated BRM’s including IL-2, 5.5 million IU daily. Initial NK% 07/21/97 was 11 and serum IAP was 650 (nl<600) . During immunotherapy NK% level fluctuated, but over months remained at 44 to 62%, during which time IAP dropped from 830 to 330. In January, 1998, NK% dropped to 3 and IAP increased to 760. Multiple severe painful metastases to the chest wall and right supraclavicular area were diagnosed. Intralesional injection with absolute alcohol relieved his symptoms and intralesional IL-2 was associated with an arrest of local cancer growth.
Patient started taking Taxol and carboplatin. In present time patient continues to take chemotherapy and BRM’s and has no symptoms of cancer recurrence.
Authors’ comments: Bronchoalveolar cancer is often refractory to systemic management. This patient’s local disappearance of gross clinical cancer after IL2 injections in a blood state of marked IAP elevation heightens the perception of anomaly.