A case of invasive mucinous adenocarcinoma presenting with massive bronchorrhea

Abstract

An 80-year-old non-smoking woman was admitted to hospital due to persistent sputum production and dyspnea. She developed respiratory failure, and chest imaging revealed multifocal consolidation and cavities. Her respiratory status did not respond to antimicrobial treatment and progressively worsened, with massive sputum production of approximately 1 L per day, and she died 19 days after admission. The patient was diagnosed with invasive mucinous adenocarcinoma based on a postmortem needle biopsy of the lung. Clinicians should consider invasive mucinous adenocarcinoma in the differential diagnosis of patients who present with massive bronchorrhea and diffuse pulmonary cavity abnormalities.

Keywords: Bronchorrhea; Cavity; Hepatocyte nuclear factor 4α; Invasive mucinous adenocarcinoma; Sputum.

Fig. 1

Chest radiograph on admission showing consolidation in the right lower lung field and patchy ground-glass opacities in both lung fields (A). Lung involvement worsened 10 days after admission (B).

Fig. 2

Chest computed tomography on admission showing multifocal consolidation with cavities and surrounding ground-glass opacities, predominantly in the lower lobes.

Fig. 3

The yellow-white sputum aspirated through the tracheal tube. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Needle necropsy of the lung showing the proliferation of atypical columnar cells with occasional intracytoplasmic mucin, associated with degenerative changes (A, C Hematoxylin and Eosin staining, B, Alcian blue staining). Atypical cells are diffusely positive for hepatocyte nuclear factor 4α (D). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)