Alessandro Del Gobbo et al., Pulmonary adenocarcinoma with massive lymphocytic infiltration: a case report with review of the literature of a rare histological entity with a peculiar biological behaviour. BMC Pulmonary Medicine

Alessandro Del Gobbo1, Stefano Fiori1, Gabriella Gaudioso1, Mario Nosotti2, Guido Coggi1, Silvano Bosari1,3, and Stefano Ferrero1,4

1Division of Pathology, Fondazione IRCCS “Ca’ Granda” – Ospedale Maggiore Policlinico, University of Milan Medical School
2Division of Thoracic Surgery, Fondazione IRCCS “Ca’ Granda” – Ospedale Maggiore Policlinico, University of Milan Medical School
3Department of Clinical/Surgical Pathophysiology and Organ Transplant, University of Milan Medical School
4Department of Biomedical, Surgical and Dental Sciences, University of Milan Medical School


Tumors with a massive inflammatory infiltration are described in several organs. There is agreement about considering the inflammatory infiltration as the host’s immune response to neoplastic cells; such neoplasms indeed have a better prognostic outcome than non-inflammatory counterparts. Only seventeen cases of pulmonary adenocarcinoma with massive lymphocytic infiltration (AMLI) have been reported in literature so far.

Case presentation
We present a case of pulmonary adenocarcinoma with massive lymphocytic infiltration occurring in a 71 years old male smoker. He came under our attention because of dyspnea, and underwent a left lower lobectomy. Histological examination showed a moderately differentiated (G2) acinar adenocarcinoma associated with a stromal desmoplastic reaction and a massive inflammatory infiltration, made up mostly of CD3+ lymphocytes. pTNM stage was pT2a, N0 (clinical stage: Ib).

Molecular testing of EGFR gene showed no mutations and immunohistochemistry for ALK resulted negative.

EBV infection was ruled out by EBV in situ hybridization.

Literature review showed seventeen similar cases, with a 16/1 male/female ratio and a mean age of 70,2 years. In eight out of seventeen cases EBV-infection was demonstrated with immunohistochemical or molecular biology techniques.

Similarly to the cases previously reported in literature our patient is a male smoker, without lymph node metastasis and he is still alive after a follow-up period of six months without recurrent or residual disease.

Because of histological, biological and clinical peculiarity, we propose to take into account pulmonary adenocarcinomas with massive inflammatory infiltration for a separate pathological classification.

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