Pulmonary adenocarcinoma: a case report

M.D. Mauro Madarena - Observations on the Report of a case of pulmonary adenocarcinoma with lymph node, hepatic and osseus metastasis - Hospital S.Camillo-Forlanini, Rome

Summary

• Male patient, 52 years old, occupation Baker. Work anamnesis positive to exposure to asbestos;
• Initial staging: clinical T, T4 N2 Mx - pathological T, III B.

January 1996

CT diagnosis of massive expansive process (5x6 cm) at the apical segment of the lower lobe of the left lung, markedly adherent to the extra-pericardial tract of the left pulmonary artery and to the left superior pulmonary vein; present conglobate and necrotic tumefactions (2,5 cm) in the left hilum (see Figure1 and Figure2 below).

January 1996: CT diagnosis of massive expansive process (5x6 cm) at the apical segment of the lower lobe of the left lung, markedly adherent to the extra-pericardial tract of the left pulmonary artery and to the left superior pulmonary vein; present conglobate and necrotic tumefactions (2.5 cm) in the left hilum.

Figure1

January 1996: CT diagnosis of massive expansive process (5x6 cm) at the apical segment of the lower lobe of the left lung, markedly adherent to the extra-pericardial tract of the left pulmonary artery and to the left superior pulmonary vein; present conglobate and necrotic tumefactions (2.5 cm) in the left hilum.

Figure2

February 1996

CT diagnosis of massive expansive process (5x6 cm) at the apical segment of the lower lobe of the left lung, markedly adherent to the extra-pericardial tract of the left pulmonary artery and to the left superior pulmonary vein; present conglobate and necrotic tumefactions (2,5 cm) in the left hilum.

• Undergoes polychemotherapeutic cycle with Etoposide oral capsule 170 mg X 3 days (Brand name VePesid - Side effects) and Carboplatin 55mg (Trade names Paraplatin and Paraplatin-AQ - Side effetcs) discontinued for severe bone marrow toxicity;
• Starts immunobiological treatment according to the rationale of Prof. Luigi Di Bella;
• Evaluation of the initial Performance Status: 40-50 degree Karnofsky, ECOG (Eastern Cooperative Oncology Group, see below) grade 3 (patient able to care for himself and only partially bedridden for more than 50% of waking hours), grade 3 pain scale Kersh-Hazra (use major narcotic drugs).

PERFORMANCE STATUS EVOLUTION:

• February 1996: Karnofsky = 40-50;
• June 1996: Karnofsky = 80 (normal activity- disease symptoms);
• April 1997: Karnofsky = 100;
• April 2001: Karnofsky = 80;
• April 2003: Karnofsky = 60;
• April 2004: Karnofsky = 50.

DISEASE EVOLUTION:

• 1996 – 1st year DBM: slight tumor regression. Clear improvement Quality of Life (Q.L.) the patient resumes his working activity;
• 1997 – 2nd year DBM: stationary neoplastic context. Continues the excellent Q.L.;
• 1998 – 3rd year DBM: no morphological variation. Endures K = 100;
• 1999 – 4th year DBM: no variation recorded;
• 2000 – 5th year DBM: during restaging CT scan evidence of mild disease progression in the lung and the emergence of liver metastases in the absence of any symptoms. Persists K = 100, the patient normally continues its work;
• 2001 – 6th year DBM: tomographic checks continue to show a gradual, though slow, increase of the lung mass and of the liver metastases, without this affecting the Q.L.;
• 2002 – 7th year DBM: trend of slight but relentless progression of the disease and, after about six years, registration of the appearance of symptoms of the disease (hepatic colics) and then a K = 80.

2003 – 8th year DBM:

Continuing slow pulmonary progression, moderate progression instead of the main mass of the liver. Increased symptoms of hepatic colic, infectious pulmonary complications, appearance of thoracic back-lumbar pains with scintigraphic evidence of probable bone metastases (see Figure3). Stops working. Karnofsky = 60.

• Tomography on January 2003 which highlights the significant liver metastatization (see Figure4).

2003: Continuing slow pulmonary progression, moderate progression instead of the main mass of the liver. Increased symptoms of hepatic colic, infectious pulmonary complications, appearance of thoracic back-lumbar pains with scintigraphic evidence of probable bone metastases. Stops working. Karnofsky = 60.

Figure3

Tomography on January 2003 which highlights the significant liver metastatization.

Figure4

2004 – 9th year DBM:

Continuing disease progression with increase particularly evident of the hepatic metastases which now replace many segments. Frequent infectious complications in both pulmonary and hepatic level, forcing the patient to hospital care (see Figure 5). Karnofsky = 50. (last restaging performed in April 2004).

Tomography February 23, 2004 which highlights the slow but steady progression of the disease particularly at the hepatic level, also noticing the repetitions bone thickening on the lumbar vertebral bodies (see Figure6a and Figure6b).

Continuing disease progression with increase particularly evident of the hepatic metastases which now replace many segments. Frequent infectious complications in both pulmonary and hepatic level, forcing the patient to hospital care. Karnofsky = 50

Figure5

Tomography February 23, 2004 which highlights the slow but steady progression of the disease particularly at the hepatic level, also noticing the repetitions bone thickening on the lumbar vertebral bodies.

Figure6a

Tomography February 23, 2004 which highlights the slow but steady progression of the disease particularly at the hepatic level, also noticing the repetitions bone thickening on the lumbar vertebral bodies.

Figure6b

Conclusions:

The case apparently seems to represent the natural evolution of a pulmonary adenocarcinoma which, over a few months, shows multiple metastasis that with rapid evolution lead to exitus on average within a year from the diagnosis. The therapeutic approach according to the immune-bio-oncological method of Prof. Luigi Di Bella has instead produced such a reduction in rate of progression of the tumor disease to allow a survival greater than eight years, thus it may well be said that we were able to obtain a long chronicization of the illness while maintaining a good performance status, these characteristics typical of the immunobiological therapies, which when meet the right receptors, allow for a long unexpected cohabitation with any neoplastic disease.

Ending with a hope, it is the writer’s hope that the future provide us with an increasing array of immunobiological drugs to do, as prof. Di Bella would say: " ...the true good of those who are suffering so much!".

Translated by: Davide Iafrate

Karnofsky performance status scale defintions rating (%) criteria.