CTICasesDiffuse Adenocarcinoma in Scleroderma
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Imaging findings
CT revealed a spatulated esophagus, extensive mediastinal soft tissue thickening, and diffuse peripheral consolidative opacities throughout both lungs. Associated findings included paraseptal emphysema, pleurisy-like plural lines, microcystic changes, air bronchograms, macrocystic changes in the left lung base, and bronchiectasis. Numerous borderline-enlarged bronchopulmonary and mediastinal lymph nodes were present. The overall imaging pattern was highly suggestive of nonspecific interstitial pneumonia (NSIP) with fibrosis and ground-glass opacities. Prior imaging showed no significant change over years.
Key takeaways
Diffuse adenocarcinoma can masquerade as common interstitial lung diseases, such as NSIP or organizing pneumonia, especially in patients with underlying conditions like scleroderma, which is associated with an increased risk of lung cancer. The presence of peripheral consolidative opacities, micro/macrocystic changes, and lymphadenopathy, even in a stable pattern over time, should prompt consideration of malignancy, particularly adenocarcinoma with a micropapillary component. A definitive diagnosis often requires biopsy, especially when expected interstitial patterns do not behave typically or when comparison studies are not readily available. This case highlighted the diagnostic challenge and the advanced stage at which such cancers often present.
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