… Discussion The word “lung cancer” is applied to tumors that arise from the respiratory epithelium (bronchi, bronchioles,

and alveoli), whereas mesotheliomas, lymphomas, and stromal tumors are different from epithelial lung cancer. The incidence of lung cancer is at its highest between ages of 55 and 65 years. Active smoking increases the relative risk of developing lung cancer by about thirteenfold, and long-term passive exposure Inhibitors,research,lifescience,medical to cigarette smoke increases it by 1.5 fold. According to the World Health Organization (WHO) classification, four major cell types constitute 88% of all primary lung neoplasms: squamous carcinomas; small-cell carcinomas; adenocarcinomas; and large cell carcinomas. Individual cell types have distinct natural histories and responses to therapy, and treatment decisions are chiefly Inhibitors,research,lifescience,medical made on the basis of whether a tumor is classified as a small cell carcinoma or as one of non-small cell subtypes. Squamous and small cell carcinomas commonly present as a central

mass with endobronchial growth, while adenocarcinomas and large cell carcinomas present as peripheral nodules or masses often with pleural involvement. A subtype of adenocarcinomas called bronchioloalveolar carcinomas grow along the alveoli Inhibitors,research,lifescience,medical without invasion and they can present radiologically as a single mass or a diffuse, multi-nodular lesion or even as fluffy infiltrate.6 Our patient was a young, non-smoking female (28 years old). She presented Inhibitors,research,lifescience,medical with cough, fever, and chest pain. Her chest radiograph demonstrated miliary mottling. Consequently, miliary tuberculosis was considered as an initial diagnosis. When three samples of sputum for AFB and the Mantoux test Akt inhibitor proved negative and thoracic CT showed

a nodular lesion suggestive of tuberculoma, the patient was subjected to CT-guided FNAC, which completely changed the diagnosis Inhibitors,research,lifescience,medical to a non-small cell carcinoma of the lung. For further management, the patient was referred to a higher oncology center, where she received chemotherapy. She survived for 8 weeks, but finally succumbed to her illness. The literature contains a small number of similar cases reported as miliary never-smoking adenocarcinoma of the lung.7 Our patient also showed striking these similarities to the 5 patients reported by Umeki8 in 1993 inasmuch as they also had non-small cell carcinoma (adenocarcinoma) of the lung with miliary metastases to the lung. The author identified these 5 cases in a consecutive cohort of 630 patients and suggested that the prevalence of miliary phenotype might be approximately 1% in Japanese patients. Moreover, he reported a short survival time after the appearance of the miliary lung metastases. Almost all histological types of lung cancer are secondary to smoking.