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Adenosquamous Carcinoma Presenting with Necrotising Mediastinal Lymphadenopathy in a Non-smoker Young Adult: A Rare Case Report

Motilal Bunkar, Rajendra Prasad Takhar, Savita Arya, Nitin Mirdha

Abstract


Introduction: Adenosquamous carcinoma (ASC) of lung is a rare and poorly described subtype of bronchogenic carcinoma. Most patients of adenosquamous carcinoma of lung come from older age group and present with cough, chest pain, weight loss, dyspnoea, haemoptysis, and fatigue. The radiologic findings of adenosquamous lung carcinoma may consist typically a peripheral solitary nodule or less commonly a central hilar mass. Here we present a unique case of adenosquamous lung carcinoma in a young adult who presented with nonspecific complaints and unusual chest X ray along with atypical findings on contrast enhanced computerised tomography in the form of necrotising mediastinal lymphadenopathy.

Presentation of Case: A 30 years old male non-smoker and non-alcoholic office worker presented at with nonspecific symptoms of dry cough and exertional dyspnoea. Physical examination revealed a single, hard, non-tender lymph node in right supraclavicular region which on excisional biopsy and histopathology revealed poorly differentiated metastatic adenosquamouscarcinoma confirmed by immunohistochemistry. Chest skiagram PA view showed bilateral nodular shadows in mid and lower zones and right paratracheal opacity. CECT thorax revealed multiple mediastinal lymph nodes with hypo areas suggestive of internal necrosis. In spite of adequate anticancer chemotherapy regimen, clinico-radiological deterioration was observed.

Conclusion: Adenosquamous carcinomas usually presents in advanced stage, show an aggressive histologic behaviour with poor survival rates than the single histology group. Early identification of such cases with varied presentation may save lives. Keeping these things in mind, early identification of such cases with varied presentation may improve survival to some extent.


Keywords


Adenosquamous carcinoma; Lymphadenopathy; Necrotising; Mediastinal

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