Tuesday, May 16, 2006

Remote lung Ca and hormone receptors

I had posted this case on two previous posts. This is a 55 y/o remote smoker with a persistent cough who had an abnormal endoBBx (squamous cell Ca) despite a normal CT scan of the chest and a negative PET scan. She had had breast Ca some five yeras ago with mastectomy, chemo/xRt and had some myocardial damage due to the adriamycin.
Many good suggestions were made to the role of inflammation in false-positive biopsies. I sent her to the chair of CT surgery at a nearby large university hospital and he was equally puzzled. While we were debating what to do, she developed new CHF, had a cath, PTCA, PM placed and and AICD. She has ischemic cardiomyopathy and was quite unstable to consider surgery right then and there. She was medically treated for her heart disease, stabilized and reassessed. Unfortunatelly, despite a negative PET three months before, on a repeat CT then PET she now had adenopathy and two small PET+ spinal mets... She was sent to oncologyand though the endoBBx looked like a squam it was poorly differentiated.
The oncologist requested staining for estrogen and progesterone receptos because of the Hx of breats Ca and those were positive.

A couple interesting questions came up.
Lung Ca (particularly adenos) can be receptor positice (I have seen a few references of over 25% positivity). With the receptor positivity would you automatically assume this is a breast Ca? Have you encountered a lot of these ER/PR+ lung Cas and does it have an impact on Tx?
If we regard that as a true late met of breast Ca, have you seen many endobronchial mets as in this case?

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