A Case of Pulmonary Pleomorphic Carcinoma Complicated by Lung Abscess and Organizing Pneumonia, Which Had Been Interpreted as Medically-intractable Severe Abscess and Pneumonia

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  • Onishi Yasutaka
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Nakahara Yasuharu
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Shiraishi Sachiko
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Kato Tomohiro
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Kagami Ryogo
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Katsuda Rinko
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Yokoi Yoko
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Mizumori Yasuyuki
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Tsukamoto Hiroaki
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Morimoto Akie
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Sasaki Shin
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Kawamura Tetsuji
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center
  • Mochizuki Yoshiro
    Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center

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Other Title
  • 内科的治療不応の肺膿瘍が疑われたが,摘出標本で器質化肺炎を伴った肺多形癌と判明した1例

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Case. A 67-year-old man initially presented for further examination of a tumor shadow in his right upper lobe, detected during a health check. A forceps biopsy via bronchoscopy revealed necrosis only and no specific diagnosis was obtained. Following this, he was referred to our hospital. His chest radiography and contrast-enhanced computed tomography (CT) showed an infiltrative shadow with an air-bronchogram, and a low-attenuation area in the infiltrates. A percutaneous biopsy under ultrasonic guidance detected two species of bacteria and necrosis, with no evidence of malignancy. We diagnosed lung abscess with bacterial pneumonia, and treated him with antibiotics (piperacillin/tazobactam, 13.5 g/day) for two weeks. However, chest CT showed exacerbation of the infiltrative shadows. We performed a right upper lobectomy because we thought his disease was medically intractable. Pathological examination of the resected material revealed pleomorphic carcinoma with suppurative inflammation inside the tumor and extensive organizing pneumonia around the tumor. Conclusion. This was an instructive case on the differential diagnosis between pleomorphic carcinoma and a lung abscess, and that between bacterial and organizing pneumonia.

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