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Adenocarcinoma of the lung. MCSC patient history

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Patient P., 37 years old, applied to the MCSC named after A.S. Loginov with complaints about:

  • progressive shortness of breath (when climbing to the 3rd floor);
  • cough with foamy sputum.

During the year, she underwent several times computed tomography of the chest organs (CT OGK). The images revealed changes in the form of areas of compaction of lung tissue, foci and "frosted glass". By the time of hospitalization, there was a negative trend – an increase in the volume of lung tissue damage.

During the examination, elevated values of the indicators responsible for the allergic reaction to mold fungi were established. It is known that the woman's apartment is on the top floor, and 2 years ago the roof leaked. However, there are no visible traces of mold on the ceiling.

A detailed analysis of the OGK CT series did not exclude an inflammatory disease of the lungs and respiratory tract caused by allergens (hypersensitive pneumonitis).  But, there were signs characteristic of other chronic diseases of the lung tissue and even lung cancer.

The patient was hospitalized in the department of pulmonology our Center, where she underwent a comprehensive diagnosis – all the necessary laboratory and instrumental diagnostic methods, including endoscopic examination of the respiratory system - fibrobronchoscopy with cryobiopsy of the lung.

This is a procedure for examining the upper and lower respiratory tracts using a flexible probe with a camera that transmits a view of the organs being examined to the screen. During cryobiopsy, a lung fragment is taken using a cooling agent, which allows to obtain a sufficient amount of tissue for morphological diagnosis.  

Histological examination of the biomaterial confirmed a malignant neoplasm – lung adenocarcinoma. The following diagnostic steps were determined at the oncological consultation - immunohistochemical examination (IHC) of the obtained material and PET-CT.

The patient had a rapid progression of the disease:

  • increasing the foci of "frosted glass" ;
  • Fever;
  • increased shortness of breath.

IHC revealed a mutation in the tumor gene of the enzyme ALK. Taking into account the result of the study, the decision of the oncological council, a specific targeted therapy was initiated. After 4 days, the patient was discharged in a satisfactory condition:

  • Body temperature has returned to normal;
  • oxygen saturation of the blood was 97-98%.

On the 2nd day after discharge, the patient underwent PET-CT, which confirmed a complete metabolic response (a marked decrease in the volume of lung tissue damage) against the background of the treatment.

The patient's history demonstrates the importance of a multidisciplinary approach in the diagnosis and treatment of lung diseases – the joint work of pulmonologists, endoscopists, anesthesiologists, oncologists, morphologists, thoracic surgeons made it possible to make the correct diagnosis in a short time, to determine the strategy and tactics of patient management.

GBUZ Moscow Clinical Scientific Center named after Loginov MHD