Development of pulmonary Langerhans cell histiocytosis in a patient with established adenocarcinoma of the lung

Or Kalchiem-Dekel, Adina Paulk, Seth J. Kligerman, Allen P. Burke, Nirav G. Shah, Renee K. Dixon

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Newly-appearing lung nodules on surveillance imaging in patients with pre-existing lung cancer can present a diagnostic dilemma when attempting to differentiate between metastatic disease, infection, and other inflammatory conditions. Here we report a case of an EGFR-/ALK-/BRAF+ metastatic adenocarcinoma patient who underwent lung biopsy for evaluation of upper-lobe predominant lung nodules revealed to represent pulmonary Langerhans cell histiocytosis (PLCH). The patient was a heavy smoker and admitted to increase her smoking habit after initially learning about her diagnosis with lung cancer. Interestingly, despite the association of both lung adenocarcinoma and PLCH with the BRAFV600E mutation in smokers, pyrosequencing of the patient's PLCH lesions was negative for this mutation. Co-occurrence of PLCH with lung cancer is extremely rare. While most reported cases of PLCH tend to precede the occurrence of lung cancer, a minority of cases appear after a diagnosis of lung cancer has already been established and are thought to represent a local immunologic reaction to the tumor. It is therefore postulated that the appearance of PLCH lesions in this patient's lungs is a result of her increase in cigarette smoking, possibly augmented by co-existence of adenocarcinoma.

Original languageEnglish
Pages (from-to)E1079-E1083
JournalJournal of Thoracic Disease
Volume9
Issue number12
DOIs
StatePublished - 1 Dec 2017
Externally publishedYes

Keywords

  • Adenocarcinoma of lung
  • BRAF mutation
  • Pulmonary Langerhans cell histiocytosis (PLCH)

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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