In my last post I outlined the typical clinical scenario for pneumonic bronchioloalveolar carcinoma (BAC), which is typically the mucinous subtype of this unusual disease. In fact, we are still actively learning a great deal about BAC, enough for the lung cancer experts to begin to develop a more sophisticated view that the mucinous and non-mucinous subtypes have different behaviors and respond differently to treatments. Here is a case that illustrates a situation that I would consider to be typical for the mucinous, pneumonic form of BAC.
Ella A. was 74 year-old woman with a very long smoking history of about 50 years, who quit last month in the face of worsening pulmonary and other symptoms. Specifically, she experienced an initial dry cough that became productive of sputum over a six-month period, during which time she also developed increasing shortness of breath and a 20-pound weight loss for a woman who was pretty slender beforehand. This led her to her primary care physician, which showed extensive “consolidation”, shadows in both lungs and particularly extensive on the left. These findings were confirmed on a CT.
(Click to enlarge)
As you might suspect, this led to a referral to a pulmonologist for a brochoscopic biopsy. The pulmonolgist needed to start her on oxygen before he could do a thorough bronchoscopy. The biopsy revealed well differentiated BAC, but the pathologist (an expert in lung pathology) didn’t have enough material to specify whether it was mucinous or non-mucinous.
Frankly, at the time when I first met her, in December of 2006, there were only the early inklings that this could be relevant. We don’t have much more information since then, except for the anecdotal experiences of myself and a few others who treatment many patients with BAC, which have corroborated the early impression that the well described effectiveness of oral EGFR inhibitors like iressa (gefitinib) and tarceva (erlotinib) in BAC appeared to be limited to the non-mucinous subtype.
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