The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 313
Poster Session
PS 1248 Pulmonology
A Comparative Study of Pemetrexed/Cisplatin Ver- sus Paclitaxel/Cisplatin in Advanced Lung Cancer with EGFR Mutation Positive Adenocarcinoma
Dongwon Lee1, Jonggeul Jang1, Kyungsu Hong1, Joonhong Ahn1, Kyungchul Shin1, Jinhong Jung1, Kwanho Lee1
Yeungnam University Mecical Center, Korea1
Background: Pemetrexed/cisplatin was approved for fi rst-line treatment of advanced lung adenocarcinoma and a number of related studies have been conducted. This comparative study evaluated PFS (progression free survival) and toxicity of paclitaxel/
cisplatin and pemetrexed/cisplatin as fi rst-line treatments for advanced stage (III~IV) lung adenocarcinoma.
Methods: Patients received paclitaxel 175 mg/m2 on day 1 and cisplatin 75 mg/m2 subsequently or pemetrexed 500 mg/m2 for 10 minutes on day 1 and cisplatin 75 mg/m2 subsequently. The treatment repeated every 3 weeks. Frequency analysis and Mann-Whitney test were used for comparison of progression free survival and toxicity between arms.
Results: Total 38 subjects participated in the study. Progression free survival was not statistically signifi cant between arms. In interim analysis, progression free survival was signifi cantly different and the occurrence of toxicity, especially related to peripheral neuropathy, was signifi cantly lower in male patients who received pemetrexed/cispla- tin. Otherwise, there was no statistically signifi cant difference in arms.
Conclusions: pemetrexed/cisplatin is not superior to paclitaxel/cisplatin, nevertheless, further researches need to be performed upon predictable factors for good effect.
PS 1249 Pulmonology
Pulmonary Lymphoma Misdiagnosed as Cryptogenic Organizing Pneumonia
Won Bae1,2, Jungsil Lee1,2, Yeon Wook Kim1,2, Jaeyoung Cho1,2, Hansol Choi1,2, HyunWoo Lee1,2, Chul-Gyu Yoo1,2
Department of Internal Medicine, Seoul National University College of Medicine Korea1, Division of Pul- monary and Critical Care Medicine, Seoul National University, Korea2
Introduction: Malignant diseases such as lymphoma should be suspected when pneu- monia or interstitial lung diseases do not respond to treatment. Herein, we report a case of large B cell lymphoma involving the lungs and bone marrow which was initially misdiagnosed as cryptogenic organizing pneumonia (COP).
Case: A 75-year-old man was admitted to another hospital for fever and myalgia. He was examined to determine the fever focus, but no specifi c cause was determined.
Empirical antibiotics were administered empirically, but respiratory symptoms and chest radiographic abnormalities, developed. He underwent PET-CT, and the observed fi ndings were comparable with that of pneumonia. Owing to his old age, he and his family refused invasive diagnostic procedures. Clinically, he was assumed to have COP; therefore, he was administered glucocorticosteroids and antibiotics. When he was administered glucocorticosteroids, his respiratory symptoms and chest radiologic abnormalities improved. However, when the glucocorticosteroid doses were tapered, his symptoms and radiologic abnormalities aggravated. Symptom improvement was observed with increasing doses of glucocorticoids; disease aggravation was repeatedly observed when the doses were reduced. During disease progression, he also devel- oped fever, pancytopenia, and abnormal liver function. The results of a bone marrow examination indicated hypocellular bone marrow. He visited our hospital for a second opinion, and he was admitted. He underwent bone marrow examination again, and it revealed large B cell lymphoma involvement. In addition, he underwent lung biopsy via video-assisted thoracoscopic surgery, and it revealed pulmonary involvement of the intravascular large B cell lymphoma accompanied by cytomegalovirus infection. He was administered R-CHOP chemotherapy and ganciclovir. Five days after the second cycle of R-CHOP chemotherapy, he developed dyspnea, hypotension, and azotemia.
Septic shock due to pneumonia or colitis was suspected and he was given antibiotics and inotropic agents, but his condition deteriorated and he died.
PS 1251 Pulmonology
Primary Pulmonary Lymphoma Misdiagnosed as Lipoid Pneumonia
Jungsil Lee1, Won Bae1, Yeon Wook Kim1, Jaeyoung Cho1, Hansol Choi1, HyunWoo Lee1, Chul-Gyu Yoo1
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National Uni- versity Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Korea1
A 54-year-old never-smoker woman visited pulmonary outpatient clinic of Seoul National University Hospital due to an abnormal chest x-ray fi nding on routine check.
She denied dyspnea, fever, chills, cough, hemoptysis or loss of weight. CAT scan of chest showed ill-defined GGO and patchy consolidation in both lower lobes (BLL).
Bronchoalveolar lavage was done and showed many lymphocytes, epithelial cells, and alveolar macrophages; oil-red O staining revealed some lipid-laden macrophages.
Although she denied history of oil ingestion, the presumptive diagnosis of lipoid pneu- monia was made. Upon initial follow-up after 1 month, there was no change on the chest X-ray. The low-dose CAT scan was followed-up 3 months later, which showed slightly increased consolidation on left lower lobe (LLL), but no significant interval change of GGO lesion on BLL. The patient was admitted to go through percutaneous needle biopsy of the LLL lesion. The pathologic result revealed atypical lymphohistio- cytic infi ltration, consistent with malignant lymphoma. Final diagnosis was extranodal marginal zone lymphoma (MALT). She has received 6 cycles of R-CVP chemotherapy, resulting in complete remission.
PS 1252 Pulmonology
A Case of Pulmonary Epithelioid Hemangioendotheli- oma Misconceived as Pulmonary Metastasis of other Malignancies
Gi Tark NOH1, Kyoung Ju LEE1, Eun Mee HAN1, Hee Jung SOHN1, Young A BAE1, Hye In LIM1
Pundang Jesaeng Hospital, Korea1
Background: Pulmonary epithelioid hemangioendothelioma (PEH) is rare, low-to-in- termediate malignant tumor of endothelial origin. Computed tomography (CT) scans of PEH characteristically demonstrate multiple, bilateral, small nodules 1-2 cm in size, presence as a solitary lung mass is uncommon. The radiographic pattern in PEH may mimic pulmonary metastasis. We reported a case of PEH in patient with colon cancer and breast cancer which was misconceived as pulmonary metastasis.
Case: A 63-year old woman who suffered constipation for about 2 weeks, visited our hospital. The colonoscopy showed a large mass with obstruction on hepatic fl exure.
The histological diagnosis was adenocarcinoma of ascending colon. Multiple nodules in both lungs and breast nodules were noted on a chest CT. A core biopsy of breast nodule was performed and a diagnosis of invasive ductal carcinoma of left breast was made. Pulmonary nodules seen on chest CT was considered as pulmonary metastasis from colon or breast cancer. Laparoscopic right hemicolectomy was performed. At the same time, wedge resection of the lung was performed for diagnosis. The pathologic examination of the pulmonary nodule revealed sclerotic and hypocellular with hyalin- ization. The tumor cells were round with abundant eosinophilic cytoplasm and intra- cytoplasmic vacuolization. Immuohistochemical analysis revealed that the tumor cells were positive for endothelial marker (CD31, CD34). As a result of the examination, the patient was diagnosed with PEH.
Conclusion: Radiologic features of PEH are diffi cult to distinguish from lung metas- tasis. We report a rare case of PEH in a patient with primary malignancy of colon and breast.
