Muhammad Khurram, S Asif Hussain Jaffery.
Bronchoalveolar Carcinoma.
J Coll Physicians Surg Pak Jan ;12(2):125-7.

A case of 70-year-old male is presented. He came with weight loss, breathlessness and bronchorrhea. There was clinical and radiological evidence of right lung`s lower lobe consolidation. Cytology of sputum and bronchial secretions led to diagnosis of bronchoalveolar carcinoma, an uncommon variety of pulmonary adenocarcinomas. He died of respiratory insufficiency about 6 months after diagnosis.

Case Reports: A 70 years old farmer, non-smoker, previously healthy male belonging to Abbottabad came with 6 months history of weight loss, breathlessness, and production of excess amount of sputum. He had been investigated in his hometown, and was diagnosed to be suffering from pulmonary tuberculosis on the basis of weight loss, high ESR, and opacity in right lower zone on chest x-ray. Three months course of anti-tuberculous therapy did not resolve any of his problems. Examination revealed an emaciated person, who was tachypneic while sitting or lying, and had signs of consolidation at right base of lung. He was continuously spitting excess amount of mucoid sputum. Figure 1 shows his chest x-ray. His 24-hour sputum was collected and was found to be about 0.6 liter, it was sent for bacteriological staining and cytology. His ESR was 90 mm after 1 hour, hemoglobin 8 g% (normocytic normochromic picture), while renal/hepatic profiles and ECG/echocardiogram/abdominal ultrasound were normal. Pulmonary function tests revealed restrictive defect. Partial pressure of oxygen and carbon-dioxide were 65 and 20 mm respectively. Bronchoscopy did not reveal any lesion, however, the airways were rapidly filling with mucoid secretions despite adequate suction and pre-procedure atropine injection. The secretions were sent for analysis.. Smears showed single and clusters of columnar bronchial cells, many of these contained terminal plates and cilia. Marked hyperchromasia, enlargement of nuclei, and spectrum of mild to quite severe nuclear atypia were noted. Final conclusion was highly atypical bronchoalveolar cells consistent with bronchoalveolar carcinoma. The patient and his family were not willing for further investigations/ treatment. He, however, continued to come for follow-up, on each subsequent visit he was found more breathless and with more deteriorated general condition. He died at his home six months after diagnosis, probable reason was respiratory insufficiency.

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