Spontaneous Regression Of Incidentally Diagnosed Bronchial Squamous Cell Lung Carcinoma After Severe Bronchitis: A Case Report
Kim, Y., Yoo, G., Lee, D. H., Lee, C. S., & Chung, C. (2021). Spontaneous regression of incidentally diagnosed bronchial squamous cell lung carcinoma after severe bronchitis: A case report. SAGE open medical case reports, 9, 2050313X211010639. https://doi.org/10.1177/2050313X211010639
View Original Source →Abstract
Spontaneous regression of lung cancer is exceptionally rare. But there have been several intriguing cases reported in early and even advanced stages of lung cancer. Although the exact mechanism remains to be elucidated, the inflammation and immunologic response have been suggested as one of the means of spontaneous regression. Chronic inflammation is generally known to induce and aggravate tumorigenesis, but the relationship between cancer and inflammation highly depends on the contexts. Here, we present a case of a 60-year-old male ex-smoker who complained of recurrent hemoptysis, cough, and purulent sputum. The initial chest CT scan revealed diffuse bronchial thickening and an endobronchial mass-like lesion in the left lingular segment. The bronchoscopic and pathological findings also suggested a diagnosis of squamous cell carcinoma with severe mucosal inflammation. He was treated with antibiotics for the bronchitis during the first 1 week and his symptoms markedly improved. After 3 weeks, he underwent a follow-up examination. Chest computed tomography and bronchoscopy revealed the significant improvement of the bronchial narrowing and mucosal edema. Biopsy was performed several times around the lesion where the tissue was initially taken. However, the pathological results showed only chronic inflammation of bronchi, not cancer cells. Fortunately, there was no recurrence of lung cancer in follow-up chest computed tomography or bronchoscopy for almost 5 years. In this case, the incidentally diagnosed bronchial squamous cell carcinoma disappeared after severe inflammatory reaction of the bronchial wall. The clinician should remind the risk of early lung cancer accompanied with bronchitis in high-risk patients of lung cancer and also be aware that although it is very rare, the lesions could spontaneously regress.
Case Details
Disease Location
Lung
Personal Characteristics
60-year-old male. History of diabetes mellitus for 12 years and was on an oral hypoglycemic agent. He was a 30-pack-year ex-smoker.
Clinical Characteristics
Referred to the hospital due to hemoptysis, cough, and purulent sputum production for 2 weeks. CT revealed diffuse bronchial wall thickening and luminal narrowing in the lobar and segmental bronchi of the left lung, suggestive of endobronchial tumor spread and severe bronchitis. Lymph nodes (lns) 1l, 7, and 9r were enlarged. Bronchoscopy showed the bronchial narrowing and edematous bronchial mucosa with suppurative inflammation of the lingular segment. Bronchoscopic biopsy demonstrated moderate-to-severe suppurative bronchitis and a few atypical cell clusters with nuclear pleomorphism and prominent nucleoli. Thorough pathology review concluded that it was consistent with squamous cell carcinoma. Alpha-hemolytic streptococcus was detected in sputum culture. After treatment with antibiotics for 7days, his symptoms significantly improved.
Remission Characteristics
3 weeks later, follow-up bronchoscopy showed that the mucosal edema with purulent inflammation had markedly improved. Repeat biopsy showed only mild chronic inflammation without cancer cells
Treatment & Mechanisms
Proposed Remission Mechanisms
Severe bronchitis may also cause epithelial denudation and immunologic reactions in the bronchial mucosa. In the process, the damaged mucosa and adjacent early cancerous lesions can be removed and replaced with new epithelium.
Clinical Treatment
Biopsy