Expectoration of Bronchogenic Carcinoma Roger Wigton, MD, and Prashant Kumar Rohatgi, MB, BS Miami, Florida
A case of expectoration of primary squamous cell bronchogenic carcinoma is reported. Only two previous cases of expectoration of grossly visible fragments of primary bronchogenic carcinoma have been reported. Interestingly enough these were also squamous cell carcinomas. Patients suspected of having pulmonary neoplasm should be instructed to save any grossly visible expectorated tissue fragments. The expectoration of lung tumors is a very rare occurrence, only six cases having been reported in the literature.1-5 Two of these cases had expectorated grossly visible fragments of primary squamous cell bronchogenic carcinomal-5 and the remainder had expectorated metastatic tumors-one adenocarcinoma from the colon,4 one osteogenic sarcoma, 2 and two malignant melanomas.3 Expectoration of the tissue was part of the presenting complaint in the two cases of primary squamous cell bronchogenic carcinoma. In the present case the lung neoplasm was expectorated during a paroxysm of coughing following fiberoptic bronchoscopy.
The hematocrit level was 40.7 percent with a leucocyte count of 18,000/cu mm. Routine blood chemistries were normal. A chest roentgenogram (Figure 1) showed left lower lobe consolidation and partial collapse. A Gram stain of the sputum revealed mixed flora with numerous polymorphonuclear leucocytes. The patient was placed on 1 megaunit of aqueous crystalline penicillin every four hours and he defervesced over the next three days with
A Case Report A 51-year-old black male, a heavy cigarette smoker, was admitted to the hospital complaining of hiccups beginning six days prior to admission. He reported having a "chest cold" with intermittent fever and night sweats for four weeks. Three days prior to admission he began producing purulent sputum. Physical examination revealed a well-nourished individual in mild respiratory distress. Blood pressure was 160/70 mmHg, pulse 110/minute and regular. Temperature was 39.2 C. Respirations were 24/minute and were constantly interrupted by hiccups. The remainder of the examination was unremarkable except for diminished excursion of the chest with decreased breath sounds over the left posterior chest.
atelectasis of left lower lobe.
From the Oak Asthma Research and Treatment Center, Pulmonary Division, University of Miami School of Medicine, PO Box 520875, Miami, Florida. Requests for reprints should be addressed to Dr. P. K. Rohatgi, Pulmonary Division, University of Miami School of Medicine, PO Box 520875, Miami, FL 33152.
Figure 2. This shows expectorated gross specimen of bronb chogenic carcinoma.
D_ s~ ~ ~ ~ ~ ~ ~ j Figure 1. Chest roentgenogram showing consolidation and
cessation of hiccups. Because of the persistent left lower lobe collapse, fiberoptic bronchoscopy was performed. It revealed a lesion obstructing the left lower lobe. A bronchial biopsy was performed. At the end of the bronchoscopy the patient had a paroxysm of cough and expectorated an almondsized greyish red fragment of tissue (Figure 2). A repeat bronchoscopy revealed only indurated and erythematous mucosa at the site of the original lesion. Histological examination of expectorated tissue and bronchial biopsy revealed a well-differentiated squamous cell carcinoma. The patient declined surgery and received radiotherapy.
Comment Expectoration of exfoliated cells from bronchogenic carcinoma is successfully utilized in the diagnosis of lung cancer by cytological examination of sputum. However, expectoration of the tumor apparently occurs very infrequently, but when it does occur, the examination of the expectorated tissue is usually diagnostic. It is of interest that this case, as well as the previously two reported cases of expectorated primary bronchogenic carcinoma, were squamous cell carcinomas. This may be due to the tendency of squamous cell carcinomas to undergo necrosis. It should be emphasized that patients suspected of having bronchogenic carcinoma should be instructed to save all the visible tissue fragments which they expectorate. Also, when a patient states that "he is coughing up pieces of his lung," it is important to evaluate the patient for the presence of a pulmonary neoplasm. Literature Cited 1. Mital OP, Agarwala MC: Expectoration of a bronchogenic carcinoma. Br J Dis Chest
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 11, 1978
62:52-53, 1968 2. Vega DL, Gomez G, Hernandez SR: Expectoracion de metastasis de sarcoma osteogenico una rareza. Pathologia (Mexico) 11:2, 1973 3. Sutton FD, Vestal RE, Creagh CR: Varied manifestations of metastatic pulmonary melanoma. Chest 64:415-419, 1974 4. Rubin FH: Pulmonary manifestations of certain abdominal and metastatic diseases in the lung as a mirror of systemic disease. Springfield, III, Charles C Thomas, 1956, p 187 5. Goldstein AR: Expectoration of bronchogenic tumor tissue. JAMA 236:1271, 1976 799
A case of expectoration of primary squamous cell bronchogenic carcinoma is reported. Only two previous cases of expectoration of grossly visible fragments of primary bronchogenic carcinoma have been reported. Interestingly enough these were also squamous cell carcinomas. Patients suspected of having pulmonary neoplasm should be instructed to save any grossly visible expectorated tissue fragments. The expectoration of lung tumors is a very rare occurrence, only six cases having been reported in the literature.1-5 Two of these cases had expectorated grossly visible fragments of primary squamous cell bronchogenic carcinomal-5 and the remainder had expectorated metastatic tumors-one adenocarcinoma from the colon,4 one osteogenic sarcoma, 2 and two malignant melanomas.3 Expectoration of the tissue was part of the presenting complaint in the two cases of primary squamous cell bronchogenic carcinoma. In the present case the lung neoplasm was expectorated during a paroxysm of coughing following fiberoptic bronchoscopy.
The hematocrit level was 40.7 percent with a leucocyte count of 18,000/cu mm. Routine blood chemistries were normal. A chest roentgenogram (Figure 1) showed left lower lobe consolidation and partial collapse. A Gram stain of the sputum revealed mixed flora with numerous polymorphonuclear leucocytes. The patient was placed on 1 megaunit of aqueous crystalline penicillin every four hours and he defervesced over the next three days with
A Case Report A 51-year-old black male, a heavy cigarette smoker, was admitted to the hospital complaining of hiccups beginning six days prior to admission. He reported having a "chest cold" with intermittent fever and night sweats for four weeks. Three days prior to admission he began producing purulent sputum. Physical examination revealed a well-nourished individual in mild respiratory distress. Blood pressure was 160/70 mmHg, pulse 110/minute and regular. Temperature was 39.2 C. Respirations were 24/minute and were constantly interrupted by hiccups. The remainder of the examination was unremarkable except for diminished excursion of the chest with decreased breath sounds over the left posterior chest.
atelectasis of left lower lobe.
From the Oak Asthma Research and Treatment Center, Pulmonary Division, University of Miami School of Medicine, PO Box 520875, Miami, Florida. Requests for reprints should be addressed to Dr. P. K. Rohatgi, Pulmonary Division, University of Miami School of Medicine, PO Box 520875, Miami, FL 33152.
Figure 2. This shows expectorated gross specimen of bronb chogenic carcinoma.
D_ s~ ~ ~ ~ ~ ~ ~ j Figure 1. Chest roentgenogram showing consolidation and
cessation of hiccups. Because of the persistent left lower lobe collapse, fiberoptic bronchoscopy was performed. It revealed a lesion obstructing the left lower lobe. A bronchial biopsy was performed. At the end of the bronchoscopy the patient had a paroxysm of cough and expectorated an almondsized greyish red fragment of tissue (Figure 2). A repeat bronchoscopy revealed only indurated and erythematous mucosa at the site of the original lesion. Histological examination of expectorated tissue and bronchial biopsy revealed a well-differentiated squamous cell carcinoma. The patient declined surgery and received radiotherapy.
Comment Expectoration of exfoliated cells from bronchogenic carcinoma is successfully utilized in the diagnosis of lung cancer by cytological examination of sputum. However, expectoration of the tumor apparently occurs very infrequently, but when it does occur, the examination of the expectorated tissue is usually diagnostic. It is of interest that this case, as well as the previously two reported cases of expectorated primary bronchogenic carcinoma, were squamous cell carcinomas. This may be due to the tendency of squamous cell carcinomas to undergo necrosis. It should be emphasized that patients suspected of having bronchogenic carcinoma should be instructed to save all the visible tissue fragments which they expectorate. Also, when a patient states that "he is coughing up pieces of his lung," it is important to evaluate the patient for the presence of a pulmonary neoplasm. Literature Cited 1. Mital OP, Agarwala MC: Expectoration of a bronchogenic carcinoma. Br J Dis Chest
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 11, 1978
62:52-53, 1968 2. Vega DL, Gomez G, Hernandez SR: Expectoracion de metastasis de sarcoma osteogenico una rareza. Pathologia (Mexico) 11:2, 1973 3. Sutton FD, Vestal RE, Creagh CR: Varied manifestations of metastatic pulmonary melanoma. Chest 64:415-419, 1974 4. Rubin FH: Pulmonary manifestations of certain abdominal and metastatic diseases in the lung as a mirror of systemic disease. Springfield, III, Charles C Thomas, 1956, p 187 5. Goldstein AR: Expectoration of bronchogenic tumor tissue. JAMA 236:1271, 1976 799
