Abstract
Background: A tuberculosis case detection in children requires large screening at school. Mostly asymptomatic children benefit from a chest X-ray that can reveal other incidental diagnosis.
Case report: A 12 year old girl with no medical history was admitted for tuberculosis suspicion. The chest X-ray revealed multiple bilateral lung nodules confirmed on the CT-scan. The tuberculosis intradermic test and all biologic and microbiologic tests remain negative. The lung biopsy showed a bronchiolo-alveolar carcinoma (BAC) with in situ K-ras G12A mutation. The patient remains asymptomatic and lung lesions were stable for 2 years. Because of the size and the number of nodules, no surgical approach was possible. At 16 years old, she still had no complain, but chemotherapy was decided because of tumoral progression with a right pleural effusion.
Discussion: BAC is a rare tumor especially in children. It is a sub-type of bronchio-alveolar adenocarcinoma, with a "lepidic" growth along the alveolar septa without invading the interstitium. Solitary nodules have a good prognosis after surgical resection whereas multifocal forms are treated with systemic chemotherapy with a generally poor prognosis. They are usually associated with K-ras mutationswithout epidermal growth factor receptor (EGFR) mutations.
Conclusion: During tuberculosis screening, an unusual aspect of chest X-ray should invite clinicians to look further for incidental lung lesions such as BAC.
- Copyright ©ERS 2015
