Lung adenocarcinoma and sequential antineutrophil cytoplasmic antibody-associated vasculitis: a case report

Abstract

The relationship between antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and lung cancer remains unclear. A 66-year-old man presented with pulmonary nodules. Histological examination of a specimen from computed tomography-guided percutaneous transthoracic biopsy revealed adenocarcinoma. The patient was treated using cryoablation and systemic chemotherapy. Sixteen months later, the patient presented with fever, nasal inflammation, recurrent lung lesions, elevated serum creatinine levels, and high levels of ANCA. Histological examination of a specimen from ultrasound-guided percutaneous renal biopsy revealed pauci-immune necrotizing crescentic glomerulonephritis. The patient responded to treatment, but granulomatosis with polyangiitis recurred and he later died. This case highlights the possibility of sequential AAV with lung cancer. Although this is relatively rare, further research is needed to better understand the association or pathophysiological link between lung cancer and AAV.

Keywords: Adenocarcinoma; antineutrophil cytoplasmic antibody-associated vasculitis; autoimmune disease; case report; granulomatosis with polyangiitis; lung cancer.

Figure 1.

Positron emission tomography (PET)/computed tomography (CT) revealed bilateral hypermetabolic lung lesions. (a) A CT revealed two nodules in the bilateral upper lung lobes. (b) PET imaging indicated abnormal fluorodeoxyglucose (FDG) uptake in the nodules. (c) A 3-dimensional maximum intensity projection reconstruction of the PET images demonstrated abnormal FDG uptake in the lung and lymph nodes.

Figure 2.

Computed tomography (CT)-guided percutaneous transthoracic lung biopsy showing adenocarcinoma. (a) A CT-guided percutaneous transthoracic needle biopsy was performed on the mass in the left upper lobe. (b) Histopathology (hematoxylin and eosin staining) revealed adenocarcinoma.

Figure 3.

Lung masses and lesions after computed tomography (CT)-guided cryoablation and chemotherapy. (a) CT after cryoablation of the mass in the left upper lung lobe (a, April 2013), the nodule in the right upper lung lobe (b, April 2013), and the nodule in the left upper lung lobe (c, May 2014). (b) The lung lesions were evaluated after cryoablation and chemotherapy, showing that the right upper lobe lesion had decreased in size, whereas the left upper lobe nodule had not (a and b, May 2014). Follow-up in October 2015 showed that both lesions, in the left and right upper lobes, had decreased in size (c and d).

Figure 4.

Sinus computed tomography (CT) and hematoxylin and eosin-stained sections. Sinus coronal (a) and axial (b) CT images revealed soft tissue filling in the left maxillary sinus, with additional soft tissue in the bilateral ethmoid sinus and right maxillary sinus. (c) Histopathology after sinus surgery (hematoxylin and eosin staining) indicated sinusitis.

Figure 5.

New nodules in the right lung in November 2015. (A) Chest computed tomography (CT) revealed new nodules in the right lung (a–d). (B) The nodules disappeared (a–d) after treatment using corticosteroids, plasmapheresis, and intravenous cyclophosphamide, followed by maintenance therapy with methylprednisolone.

Figure 6.

Histological examination (hematoxylin and eosin staining) of the ultrasound-guided percutaneous renal biopsy specimen revealed pauci-immune necrotizing crescentic glomerulonephritis.

Figure 7.

Chest computed tomography (CT) revealed new bilateral lung lesions in May 2017.

Figure 8.

Computed tomography (CT) revealed left sinusitis. (a) CT revealed mild mucosal thickening in the ethmoid, sphenoid, and left maxillary sinus. (b) Positron emission tomography showed no remarkable fluorodeoxyglucose uptake in the sinuses.