key: cord-0940172-9ep3wcg9
authors: Elabbadi, Alexandre; Fajac, Anne; Antoine, Martine; Cadranel, Jacques; Voiriot, Guillaume; Fartoukh, Muriel; Gibelin, Aude
title: A Severe COVID-19 Pneumonia Revealing a Lepidic Adenocarcinoma: A Diagnostic Challenge during the Pandemic Period
date: 2021-12-01
journal: American journal of respiratory and critical care medicine
DOI: 10.1164/rccm.202104-0826im
sha: 66e382f0149541a67c17d3241c77fc049b5e4a87
doc_id: 940172
cord_uid: 9ep3wcg9

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extension of the alveolar consolidation associated with bilateral ground-glass opacities ( Figure 1B ). In view of the atypical presentation with frothy sputum and the prolonged course of the pneumonia, a fiberoptic bronchoscopy was performed to look for another diagnosis. The BAL showed 360,000 cells/ml, of which more than 80% were carcinomatous cells suggestive of a lepidic adenocarcinoma (Figures 2A and 2B ). Transbronchial biopsies confirmed the diagnosis of lepidic adenocarcinoma with the presence of adenocarcinomatous cells in collapsed alveoli ( Figures 3A and 3B ). Corticosteroid therapy was pursued for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, in association with a chemotherapy combining carboplatin, pemetrexed, and bevacizumab. The patient was discharged from the ICU 7 days later. 

Lepidic adenocarcinoma is a well-differentiated adenocarcinoma developed along intact alveolar septa without invasion of the stroma, pleura, or vessels (1) . The clinical spectrum of symptoms is broad and may ultimately lead to acute respiratory failure (2, 3) . Thoracic imaging may mimic an infectious etiology (3, 4) , mainly ground-glass attenuation, which is also frequently found during the COVID-19 pandemic (5, 6) . In this context, the diagnosis may be challenging and warrants cytologic respiratory samples in case of atypical presentation of "acute pneumonia."

Author disclosures are available with the text of this article at www.atsjournals.org.

international multidisciplinary classification of lung adenocarcinoma

Refractory hypoxemic respiratory failure due to adenocarcinoma of the lung with predominant bronchioloalveolar carcinoma component

Clinical characteristics of pneumonic-type adenocarcinoma of the lung

Bronchioloalveolar carcinoma: computed tomography findings

CT imaging features of 2019 novel coronavirus (2019-nCoV)

Measurement of localized ground-glass attenuation on thin-section computed tomography images: correlation with the progression of bronchioloalveolar carcinoma of the lung