Cannon ball opacities in lungs are usual manifestation of secondary’s arising due to extra-thoracic malignancy. We report a rare case of primary lung cancer with presentation of multiple pulmonary nodules in a 62-year-old male laborer by occupation, chronic smoker (40 pack-years) who presented with 6 month history of dry cough, exertional breathlessness and fever off and on.
Case Study
A 62-year-old male laborer by occupation, chronic smoker (40 pack-years) presented with history of dry cough, exertional breathlessness, fever off and on since last 6 months. He was diagnosed as pulmonary tuberculosis from private sector and was on anti-tubercular drugs for last four months without any respite. General physical examination revealed swelling over neck and face, pallor, clubbing, cervical lymphadenopathy, and engorged neck veins. Sputum was negative for acid-fast bacilli (AFB) and patient was non-reactive to HIV tests. Vitals and other systemic (cardiac, skeletal, gastrointestinal, and genito-urinary) examinations were unremarkable. Chest X-ray showed multiple bilateral pulmonary nodules/cannon ball opacities [Figure 1]. Contrast-enhanced computed tomography of chest and abdomen showed multiple hypodense well-defined round lesions in both lung fields; lymph node were noticed in bilateral hilar, paratracheal, pre-carinal, carinal, sub-carinal region; lymph node mass was seen compressing superior vena cava with no abnormality detected in the abdomen. Fiberoptic bronchoscopy showed sluggish left vocal cord movement with trachea having endobronchial growth. Biopsy from growth revealed poorly differentiated squamous type carcinoma. Ultrasound-guided percutaneous fine needle aspiration cytology (FNAC) from one of the lung opacity also revealed poorly differentiated squamous type carcinoma. Immuno-histochemistry evaluation of both the samples was positive for cytokeratin and negative for synaptophysin, chromogranin, and neuron-specific enolase.
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