The end of this report is to describe an association between bronchogenic carcinoma and HIV.

The end of this report is to describe an association between bronchogenic carcinoma and HIV. Three HIV-seropositive patients are described who expanded bronchogenic cancer (two large lonely dwelling one adenocarcinoma) before developing an AIDS-defining illness. A critical review of the literature revealed 22 other patients in which the association of HIV infection and lung cancer is reported. These patients are characterized through a relatively young age at diagnosis (median, 43 years) and prevalence of the adenocarcinoma subtype (13 of 25 patients). Twenty of 21 patients had a history of smoking. Among 21 patients for whom data were available, 6 patients (28 percent) had AIDS at time of diagnosis of lung cancer while 11 patients (55 percent) did not have AIDS or AIDS-related compages at diagnosis. (Chest 1994; 106:640-42)

AZT=zidovudine

Patients infected with HIV often develop pulmonary complications.[1,2] Although lung abnormalities in AIDS usually end from pulmonary infection, malignancies as it was as Kaposi's sarcoma and non-Hodgkin's lymphoma meet the eye with markedly increased frequency in AIDS patients.[3,4] Lung cancer, however, has not classically been associated with HIV infection. This report details three cases of HIV-infected patients who exhibited bronchogenic carcinoma. Other published reports are reviewed, suggesting a causal association between HIV infection and lung cancer.

Case Reports

Case 1

A 50-year-old HIV-positive, bisexual man instanted in November 1991 with a 3-month history of an intermittent right-sided chest and shoulder pain. He had a 30-pack-year smoking history and had been taking zidovudine (AZT) for 4 years. He had a CD4 calculate of 240 in October 1991 There was no history of lymphadenopathy or AIDS-defining illness. The patient reported a 45-kg weight los across the previous 8 months on the contrary had no fever, cough, dyspnea, or hemoptysis. Physical examination revealed marked finger clubbing and tachypnea. There were several 05-cm mobile lymph nodes in the posterior triangle of the right side of the neck and bilateral distention of the external jugular, arm, and chest veins. A chest radiograph revealed a 4X5X5-cm soft-tissue mass in the right hilum. A comput tomographic (CT) scan of the thorax revealed a 5X7-cm right hilar mass causing near total compression of the superior vena cava along with a 15-cm right upper lobe nodule and another 1-cm nodule in the lingula. A percutaneous needle biopsy specimen from the right hilar mass revealed a large-cell anaplastic carcinoma. A bone scan and abdominal scan did not reveal extrapulmonary metastases. The patient was treated with radiotherapy, receiving 2000 cGy in five fractions in December 1991 He make knowned a recurrence of right-sided chest pain and hemoptysis in March 1992 and received a next to the first course of palliative radiotherapy. In October 1992 the patient expanded symptoms of urinary incontinence without evidence of spinal cord compression. He was admitted to hospital for palliative care and died in December 1992

Case 2

A 51-year-old bisexual man existinged in January 1992 with a 3-month history of cough and hemoptysis. The patient had a 24-pack-year smoking history and had stopped smoking 6 years prior to presentation. In 1988 he make knowned generalized lymphadenopathy, was found to HIV-positive, and began therapy with AZT. In September 1991 the patient's CD4 number was 170. He then disentangleed hemoptysis in October 1991. A chest radiograph showed a right lower lobe interstitial infiltrate for which he was treated empirically with trimethoprim-sulfamethoxazole. In January 1992 his chest radiograph demonstrated increasing infiltrative changes in the right lung and right perihilar region as well as atelectasis of the right base. An endobronchial biopsy specimen of tumor seen in the right lower lobe bronchus demonstrated large-cell anaplastic cancer. Metastatic workup disclosed no abnormalities. In February 1992 a of recent origin right pleural effusion developed. Cytologic examination of pleural fluid was consistent with adenocarcinoma. Pleurodesis of the right pleural cavity was performed; however, the patient had progressive parenchymal lung infiltration with tumor and return of bilateral malignant pleural effusions. He died in hospital in March 1992

Case 3

In October 1990 an asymptomatic 60-year-old homosexual man was place to be HIV-positive with a CD4 deem of 180. Therapy with AZT was begun. The patient had a 30-pack-year history of smoking if it be not that had quit 3 years earlier. Following the diagnosis of HIV infection, the patient had a routine chest radiograph that disclosed the appearance of a right upper lobe mass and right hilar adenopathy. A CT scan of the thorax showed an irregular 2-cm mass in the anterior portion of the right upper lobe and right-sided mediastinal adenopathy. A fine-needle aspirate of the right upper lung lesion was done in March 1991 demonstrating adenocarcinoma. Metastatic workup disclosed no abnormalities. In April 1991 he had a mediastinoscopy that revealed adenocarcinoma in the right paratracheal nodes. The patient underwent radiation therapy in July 1991 to his primary lung tumor. He remained well until June 1992 when he noted cough and weight los Chest radiograph showed partial collapse of the right upper lobe with a right pleural effusion as well as multiple soft-tissue nodules that had cause to growed in both lung fields. When last assessed in July 1992 he was still alive however his condition was clinically deteriorating from progressive cancer.

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