CTICasesPulmonary Adenocarcinoma arising in Fibrosing NSIP
Imaging findings
High-resolution CT of the chest in a patient with dermatomyositis shows a classic fibrosing non-specific interstitial pneumonia (NSIP) pattern, characterized by basilar-predominant ground-glass opacities, traction bronchiectasis, and subpleural sparing. On follow-up CT, a new, solid, FDG-avid nodule is seen arising within an area of preexisting fibrosis in the left lung base, which upon resection was diagnosed as a lipidic-predominant invasive adenocarcinoma.
Key takeaways
Patients with connective tissue disease-associated interstitial lung disease (CTD-ILD), such as dermatomyositis-associated NSIP, are at an increased risk of developing lung cancer. Identifying a developing malignancy within areas of preexisting fibrosis can be highly challenging, as the tumor may initially blend with or mimic progressive fibrotic changes. Any asymmetric, progressive, or solid nodule arising in a background of ILD should raise suspicion for primary lung cancer.
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