Mucinous adenocarcinoma of the lung diagnosed by radial endobronchial ultrasound-guided bronchoscopic cryobiopsy and presenting as interstitial lung disease in a patient with systemic sclerosis Lin YT, Lin CH, Wang SC, Huang YJ, Wu RC, Lee CS, Chang CH, - J Indian Prosthodont Soc

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Mucinous adenocarcinoma of the lung diagnosed by radial endobronchial ultrasound-guided bronchoscopic cryobiopsy and presenting as interstitial lung disease in a patient with systemic sclerosis Yan-Ting Lin¹, Chiung-Hung Lin², Shao-Chung Wang³, Yun-Ju Huang⁴, Ren-Chin Wu⁵, Chung-Shu Lee⁶, Chih-Hao Chang⁶ ¹ Department of Internal Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan ² Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan ³ Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, New Taipei City; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ⁴ Department of Allergy, Immunology, Rheumatology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan ⁵ Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan ⁶ Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei; Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan Correspondence Address: Chih-Hao Chang, No. 5, Fuxing Street, Lin-Kou Chang Gung Memorial Hospital, Guishan, Taoyuan 333 Taiwan Source of Support: None, Conflict of Interest: None

We report a patient with systemic sclerosis who was diagnosed with advanced-stage mucinous adenocarcinoma of the lungs. The clinical presentation, imaging findings, pathological results, and molecular diagnoses are presented. A 64-year-old woman with systemic sclerosis was administered prednisolone and hydroxychloroquine sulfate to control her disease. High-resolution computed tomography (HRCT) revealed an interstitial pattern in both lungs during annual imaging. Connective tissue disease-associated interstitial lung disease (CTD-ILD) was diagnosed using blood tests, pulmonary function tests, and imaging findings. One year later, the patient underwent follow-up chest HRCT, which showed progressive lung disease. The patient underwent endobronchial ultrasound (EBUS)-guided transbronchial lung cryobiopsy and computed tomography-guided biopsy for a pathological diagnosis. The pathology reports of bilateral lungs disclosed mucinous adenocarcinoma. After tumor staging and mutation testing, the patient received chemotherapy with pemetrexed and cisplatin. The bilateral lung lesions subsided after four cycles of first-line chemotherapy. Patients with CTD and lung involvement may be diagnosed with CTD-ILD. Although histopathological results are not mandatory for ILD diagnosis, EBUS-guided transbronchial lung biopsy or lung cryobiopsy should be considered when ILD has atypical or unexplained features.

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