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A Case of Squamous Cell Carcinomatous Lung Abscess with Multiple Metastatic Abscesses

다발 전이성 농양을 일으킨 편평상피세포암성 농양 1예

  • Lim, Ju Eun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Eun Young (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jang, Ji Eun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Son, Ji-Young (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jung, Ji Ye (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Byung Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Kyung Jong (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Yoon, Yeo Wun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Byun, Min Kwang (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Sa Rah (Department of Pathology, Yonsei University College of Medicine) ;
  • Kang, Young Ae (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Moon, Jin Wook (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Moo Suk (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Young Sam (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jang, Joon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Young Nyun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Se Kyu (Department of Internal Medicine, Yonsei University College of Medicine)
  • 임주은 (연세대학교 의과대학 내과학교실) ;
  • 김은영 (연세대학교 의과대학 내과학교실) ;
  • 장지은 (연세대학교 의과대학 내과학교실) ;
  • 손지영 (연세대학교 의과대학 내과학교실) ;
  • 정지예 (연세대학교 의과대학 내과학교실) ;
  • 박병훈 (연세대학교 의과대학 내과학교실) ;
  • 이경종 (연세대학교 의과대학 내과학교실) ;
  • 윤여운 (연세대학교 의과대학 내과학교실) ;
  • 변민광 (연세대학교 의과대학 내과학교실) ;
  • 이사라 (연세대학교 의과대학 병리학교실) ;
  • 강영애 (연세대학교 의과대학 내과학교실) ;
  • 문진욱 (연세대학교 의과대학 내과학교실) ;
  • 박무석 (연세대학교 의과대학 내과학교실) ;
  • 김영삼 (연세대학교 의과대학 내과학교실) ;
  • 장준 (연세대학교 의과대학 내과학교실) ;
  • 박영년 (연세대학교 의과대학 내과학교실) ;
  • 김세규 (연세대학교 의과대학 내과학교실)
  • Received : 2009.05.11
  • Accepted : 2009.05.18
  • Published : 2009.05.30

Abstract

Among the bronchogenic carcinomas, especially squamous cell carcinoma and large cell carcinoma frequently present with cavitation, which may result from tumor necrosis. Cavitary lesions of the tumor are occasionally associated with infection and misdiagnosed as benign lung abscess owing to the partial responsiveness to antibiotics. It is very difficult to distinguish the carcinomatous abscess from the benign lung abscess, because of their similar clinical and radiologic features. Delay in diagnosis of underlying lung cancer may result in poor outcome. Therefore, clinicians should remember that the patients with highly suspicious carcinoma of the lung should undergo further precise examinations to find out malignant cells.

기관지폐쇄에 의한 폐농양 혹은 공동성 병변에 발생한 암성 농양은 임상 양상 및 방사선학적 소견이 흡인성 폐농양과 흡사하여 감별이 어려워서 폐암을 조기 진단할 수 있는 기회를 놓치기 쉽다. 따라서 항생제에 대한 반응이 뚜렷하지 않거나 선행 요인이 없고 비전형적인 위치에 발생한 폐농양의 경우 악성 병변의 동반 가능성을 염두에 두고 적극적인 검사가 필요하다. 저자들은 발열, 기침, 혈담, 호흡곤란을 주소로 내원하여 폐농양 의심하에 항생제 치료에도 불구하고 병변이 악화된 67세 남자 환자에서 간세침흡인생검을 통해 다발 전이성 농양을 일으킨 편평상피세포암성 농양으로 진단된 예가 있어 문헌 고찰과 함께 보고하는 바이다.

Keywords

References

  1. Fishman AP. Chapter 112. Approach to the patient with pulmonary infection. In: Fishman JA, editor. Fishman's pulmonary diseases and disorders. 4th ed. New York: McGraw-Hill Medical; 2008. p. 1988-89
  2. Bernhard WF, Malcolm JA, Wylie RH. The carcinomatous abscess: a clinical paradox. N Engl J Med 1962;266:914-9 https://doi.org/10.1056/NEJM196205032661804
  3. Stewart CE, Winer-Muram HT, Jennings SG, Dowdeswell I, Meyer CA. Necrotic mass-like upper lobe opacity. Chest 2003;123:277-9 https://doi.org/10.1378/chest.123.1.277
  4. Liao WY, Liaw YS, Wang HC, Chen KY, Luh KT, Yang PC. Bacteriology of infected cavitating lung tumor. Am J Respir Crit Care Med 2000;161:1750-3 https://doi.org/10.1164/ajrccm.161.5.9905103
  5. Sosenko A, Glassroth J. Fiberoptic bronchoscopy in the evaluation of lung abscesses. Chest 1985;87:489-94 https://doi.org/10.1378/chest.87.4.489
  6. Kurihara Y, Nakajima Y, Niimi H, Arakawa H, Ishikawa T, Kojima K, et al. Cavitary lung cancer producing granulocyte colony-stimulating factor: a mimicker of lung abscess. J Comput Assist Tomogr 1998;22:425-6 https://doi.org/10.1097/00004728-199805000-00014
  7. Schiza S, Siafakas NM. Clinical presentation and management of empyema, lung abscess and pleural effusion. Curr Opin Pulm Med 2006;12:205-11
  8. Wallace RJ Jr, Cohen A, Awe RJ, Greenberg D, Hadlock F, Park SK. Carcinomatous lung abscess: diagnosis by bronchoscopy and cytopathology. JAMA 1979;242:521-2 https://doi.org/10.1001/jama.242.6.521
  9. Sokhandon F, Sparschu RA, Furlong JW. Best cases from the AFIP: bronchogenic squamous cell carcinoma. Radiographics 2003;23:1639-43 https://doi.org/10.1148/rg.236035007
  10. Mathew BS, Jayasree K, Gangadharan VP, Nair MK, Rajan B. Renal metastasis from squamous cell carcinoma of the lung. Australas Radiol 1998;42:159-60 https://doi.org/10.1111/j.1440-1673.1998.tb00597.x
  11. Akduman B, Altun R, Yesilli C, Yenidunya S, Ozdemir H, Mungan NA. Symptomatic renal metastasis 5 years after the management of a squamous cell carcinoma of the lung. Int J Urol 2004;11:421-3 https://doi.org/10.1111/j.1442-2042.2004.00810.x