Publication: Rheumatoid nodule and combined
pulmonary carcinoma: topographic correlations;
a case report and review of the literature
Authors
Spina, Donatella ; Ambrosio, Maria Raffaella ; Rocca, Bruno Jim ; Di Mari, Nicoletta ; Onorati, Mónica ; Luzzi, Luca ; Monciatti, Irene ; Tosi, Piero
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Publisher
Murcia: F. Hernández
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DOI
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info:eu-repo/semantics/article
Description
Abstract
An association between rheumatoid arthritis
(RA) and malignancies has been ascertained and patients
with RA appear to be at higher risk of lymphoma and
lung cancer. The higher risk of the latter malignancy
may be related to rheumatoid interstitial lung disease and
immunosuppressive therapies.
Herein we illustrate the case of a 59-year-old male
smoker affected by RA and treated with cortisone,
methotrexate and TNF-α antagonists, who underwent
right lower lobectomy for a nodular lesion. On
microscopic examination, the lesion consisted of two
distinct areas: a central area of fibrinoid necrosis,
bordered by histiocytes in a palisaded arrangement,
lymphocytes and a 0.4 cm thick peripheral area
constituted by a combined small cell anaplastic
carcinoma, adenocarcinoma and squamous cell
carcinoma. The combination of three histotypes is very
rare in such a small tumour. In our case, it may be
hypothesized that synchronous, heterogeneous mutations
occurred in different type of committed cells or in stem
cells, due to the production of cytokines by RA nodule
histiocytes and lymphocytes, which are contiguous to the
carcinomatous area. Since few studies have evaluated
the topographic correlation between tumors and
rheumatoid lung lesions, further morphological and
molecular studies are needed to clarify this association
and the pathogenetic relationship between RA and
cancer of the lung.
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