Pulmonary Malignant Tumours Initially Diagnosed As "Pneumonia":A Report Of 2 Cases And Clinical Speculation

Objectives:To improve clinicians' understanding of lung malignant tumours with"pneumonia"-like manifestations and enhance the ability of differential diagnosis of pulmonary disease by analyzing the diagnosis and treatment of 2 cases of pulmonary malignancies which were initially diagnosed as "pneumonia".Methods:The detailed clinical data of 2 cases of pulmonary malignancies diagnosed as "pneumonia" were reported;summarize and analyze the diagnosis and treatment process;to further explore the pathogenesis,diagnosis and differential diagnosis of three types of pulmonary malignancies according to search domestic and foreign medical literature database.Results:Case 1:Female,32 years old,"Fever with cough and sputum for more than 2 months."CT scan of the chest showed a large high-density shadow of the left lower lobe,scattered lung nodules and hilar mediastinal lymph nodes.Bronchoscopy biopsy showed inflammatory changes.During the period,Antibiotics,anti-tuberculosis drugs and antifungal drugs were given,but lung lesions were still progressed.Then,pulmonary lymphoma was diagnosed by percutaneous lung biopsy and immunohistochemistry.The patient was transferred to the Department of Hematology for further treatment.PET-CT showed abnormal uptake of multiple tissue organs(double lungs,abdominal cavity,pelvis,multi-regional lymph nodes and multiple bones/medulla)(SUVmax 5.7-40.7).The final diagnosis is Hodgkin's lymphoma(?stage)--external pulmonary involvement.The patient refused treatment and left hospitalCase 2:A 69-year-old woman was admitted to the hospital due to "repeated coughing and breathlessness for 11 months and more than 1 month".She had been to a local hospital,and chest CT showed ground glass of both lungs,suggesting interstitial changes.The patient was diagnosed with "interstitial pneumonia" and given glucocorticoid therapy.The pulmonary lesions were improved.The patient's condition was stable and aggravated again after 10 months.Chest CT in the out-hospital showed that bilateral lobes were scattered in high-density flaky shadows,and the left lung and the right lower lobe were significant.After 2 weeks of treatment with corticosteroids and antibiotics,the patient's condition was progressed.She was admitted to our hospital as "pneumonia".The pathology showed inflammatory changes by transbronchial lung biopsy;Lung mucinous adenocarcinoma was diagnosed by percutaneous lung biopsy.The chemotherapy regimen "pemetrexed disodium combined with carboplatin" was given.The patient's symptoms were improved significantly.She died 3 months later due to no regular chemotherapy.Conclusions:1.Clinically,some pulmonary tumors,especially those with exudative consolidation on imaging are more likely to be misdiagnosed.Clinicians should be sufficient vigilant during the diagnosis and treatment2.Sometimes,the pathology should not be satisfied once in the diagnosis process due to the different locations,methods and implementers of the bronchus-lung biopsy.It is necessary to give repeated or even multiple pathological biopsies in time.