New lung mass in a patient with granulomatosis with polyangiitis

Abstract

Granulomatosis with polyangiitis (GPA) is a potentially lethal ANCA-associated small-vessel vasculitis characterized by a typical triad of upper respiratory tract, lung, and kidney involvement. Lung involvement in GPA occurs in 25–80% of cases. The most common radiographic and computed tomography (CT) abnormalities of pulmonary GPA are lung nodules and masses, very often multiple and with cavitation. As there are various clinical presentations, the diagnosis of GPA can be challenging, and the illness is difficult to distinguish from other diseases such as infection or malignancy. Following the improved survival rates in patients with GPA, there is accumulating evidence to suggest an increased occurrence of different types of cancer. Exposure to cyclophosphamide seems to be one of its main causes. We present the case of a patient with chronic GPA who was hospitalized owing to a new infiltrate in the lung, suggesting relapse of the disease, and finally diagnosed with small cell lung cancer. Data regarding lung cancer in GPA patients are limited. While there are some case reports and short case series in the literature, there are no detailed data regarding an association between CYC exposure and lung cancer development in vasculitis. It is necessary to consider the causes of pulmonary masses other than a GPA relapse. Bronchoscopy with biopsy and histopathological examination are crucial in proper differential diagnosis. GPA patients require long-term follow-up to monitor for the development of complications during treatment.

Lung adenocarcinoma and sequential antineutrophil cytoplasmic antibody-associated vasculitis: a case report

“…Although rare, some reports have described the development of pulmonary malignant diseases in patients treated for AAV. 15,16 In the present case, AAV manifested after pre-existing cancer. The initial presentation included pulmonary nodules, which were diagnosed as lung adenocarcinoma on the basis of histopathology.…”

Uncommon Presentation of Granulomatosis with Polyangiitis Mimicking Metastatic Lung Cancer

“…Conversely, there is an extensive number of malignancy studies during AAV follow-up [24][25][26][27][28]. The course of the disease with frequent relapses can be a challenge as lung tumors can be difficult to distinguish from pulmonary AAV activity [29]. In this study, the authors screened PubMed for relevant publications on AAV and pulmonary malignancies and found six GPA patients with associated lung cancer; only one was diagnosed during the first year of GPA diagnosis.…”

A case of granulomatosis with polyangiitis mimicking lung malignancy

“… 6 Furthermore, GPA is itself associated with an increased risk of malignancy, including the risk of pulmonary malignancy. 2 Conversely, coexisting granulomatous inflammation may be seen on histopathology specimens amongst patients with lung cancer, possibly reflecting previous mycobacterial infection or granulomatous reaction to malignancy. 7 In our case, our clinical suspicion of malignancy remained sufficiently high following the initial lung biopsy that a second biopsy was pursued, which assisted in confirming the diagnosis of GPA.…”

“…1 This presentation may mimic lung malignancy, including amongst patients with diagnosed GPA, which has been shown to increase malignancy risk including for lung cancer. 2 We report a case of GPA mimicking lung cancer in a 45-year-old man presenting with cough, haemoptysis and weight loss on a background of a significant past smoking history.…”

“… 1 This presentation may mimic lung malignancy, including amongst patients with diagnosed GPA, which has been shown to increase malignancy risk including for lung cancer. 2 …”