Question

Question from Informatic pathology subject in bioinformatics, need answers in essay form for 25 marks

A 60-year-old man, presented with complaints of cough and expectoration for the past 7–8 months. The expectoration was around 100 ml/day, mucoid and no foul smelling. Patient also complains of chest pain, breathlessness, fever and weight loss.  Sputum for AFB was done twice and it was negative. We proceeded with a diagnostic bronchoscopy. There were no endobronchial lesions. Bronchial wash from the right lower lobe revealed numerous acid fast bacilli. Describe the types of inflammation based on the above case study. Then, discuss on the pathogenesis of the lesion that later developed to necrotized tissues.

[25 Mark]

Answer 1

ANSWER :-

The type of inflammation in the above case study initially seems to be tuberculosis but after bronchoscopy it looks like an lung malignancy. The pulmonary tuberculosis found to be in 0.7% cases of lung cancer. In above case study, the initial inflammation is from pulmonary tuberculosis but on further investigation it was diagnosed to have co-existence Adenocarcinoma with lepidic pattern. Adenocarcinoma with lepidic pattern formerly called as Bronchioalveolar cell carcinoma (BACs), in around 5-24% of lung cancer, this BACs increased significantly. The pathogenesis of the lesions later developed in to necrotized tissue develop in to lung cancer. As when sputum for AFB was done twice , it was negative. But after bronchoscopy, the acid fast bacilli appear to be in right lower lobe.

The patient in above case study shows the symptoms of bronchorrhea but was not dyspenic. He seems to have diffuse infiltrative variety of BAC which is less common form of presentation and has a poorer diagnosis. It also appear to have a theory of 'reverse causality' which explains that lung cancer may provoke reactivation of latent tuberculosis infections by weakening host immune mechanisms and the lung cancer is usually diagnosed in the 6-9 months of TB infection.