Lung Cancer in Chronic Hypersensitivity Pneumonitis

Background: So far, the association of lung cancer with chronic hypersensitivity pneumonitis (CHP) has not been studied. Objective: We examined the prevalence and revealed clinical features of lung cancer in CHP. Methods: We retrospectively reviewed the medical records from 1994 through 2005 and identified 11 patients (15 lesions) with lung cancer among 104 patients with CHP. Their clinical features and histopathological findings were analyzed. Results: Ten men and 1 woman with a median age of 68.9 years were included. All patients had a smoking history. The most prevalent histopathological type of lung cancer was squamous cell carcinoma (53%), and all tumors were located in the peripheral region of the lung. Four patients suffered from lung cancer after the diagnosis of CHP and 1 patient had lung cancer before the diagnosis of CHP. The histological pattern of CHP showed a predominantly usual interstitial pneumonialike lesion. Tumors were located adjacent to honeycombing in 7 (47%) of 15 lesions, bullae in 4 (27%) lesions, and relatively normal lung in 4 lesions. Conclusions: Since the prevalence of lung cancer in CHP seems to be high (10.6%) as seen in idiopathic pulmonary fibrosis, physicians should be aware of the possible complication of lung cancer in CHP. Copyright © 2011 S. Karger AG, Basel Received: October 28, 2010 Accepted after revision: March 23, 2011 Published online: May 31, 2011 Naohiko Inase, MD Department of Integrated Pulmonology Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo 113-8519 (Japan) Tel. +81 3 5803 5950, E-Mail ninase.pulm @ tmd.ac.jp © 2011 S. Karger AG, Basel 0025–7931/11/0823–0263$38.00/0 Accessible online at: www.karger.com/res Kuramochi /Inase /Miyazaki /Kawachi / Takemura /Yoshizawa Respiration 2011;82:263–267 264 tients (10.6%) who suffered from lung cancer as well as CHP. This study conformed to the Declaration of Helsinki and was approved by the institutional review board. Diagnostic Criteria of CHP The diagnostic criteria for CHP was 3 or more of the following (including 5, either 2 or 3, and either 1 or 6): (1) reproduction of symptoms of HP by an environmental provocation or laboratorycontrolled inhalation of the causative antigen; (2) evidence of pulmonary fibrosis with or without granulomas; (3) honeycombing on computed tomography scans; (4) progressive deterioration of a restrictive impairment on pulmonary function over 1 year; (5) over 6 months’ duration of respiratory symptoms related to HP, or (6) antibodies and/or lymphocyte proliferation to the presumed antigen [2] . Immunological Examinations Specific antibodies in sera and BAL fluids were measured by an enzyme-linked immunosorbent assay [11] . An antigen-induced lymphocyte proliferation test using peripheral lymphoTable 1. Patient characteristics Case Sex A ge at diagnosis of Smoking BI Occupation lung cancera CHP IPF 1 M 71, 73 72 71b S 1,800 tailor (kimono) 2 M 66 67 66b S 1,200 leather worker 3 M 66 66b – Ex 2,180 shoemaker 4 M 67 67b – S 470 janitor 5 F 68 60 – Ex 100 homemaker 6 M 83 73 – Ex 600 sales assistant of furniture 7 M 70, 74 77 70b Ex 1,000 book dealer 8 M 70, 75 77 – Ex 1,020 pub keeper 9 M 70 69 63 Ex 920 researcher 10 M 65 67 65b Ex 2,400 mail officer 11 M 62, 66 62 60 S 1,760 advertising agent S = Current smoker; Ex = ex-smoker; BI = Brinkman index (number of cigarettes per day multiplied by years). a Cases 1, 7, 8 and 11: patients suffered twice from lung cancer. b Simultaneously diagnosed as lung cancer. Table 2. Causative antigens and immunological findings in CHP Case Type of CHP Causative antigens Specific antibody LST Provocation test 1 BRHP next to bird shop; feather duvet; small birds – + + 2 BRHP many pigeons; silky fowl; pigeons – + + 3 BRHP parakeet; feather duvet + – + 4 BRHP unknown + + + 5 BRHP many pigeons + + + 6 BRHP parakeet – + + 7 BRHP stuffed pheasant – + + 8 BRHP parakeet + + + 9 BRHP wild birds + + + 10 SHP Trichosporon asahiia + + + 11 SHP Trichosporon asahii + ND + S HP = Summer-type hypersensitivity pneumonitis; LST = lymphocyte stimulation test; ND = not done. a Mold in house.