title: Rheumatoid nodule and combined pulmonary carcinoma: topographic correlations; a case report and review of the literature.
abstract: An association between rheumatoid arthritis (RA) and malignancies has been ascertained and patients with RA appear to be at higher risk of lymphoma and lung cancer. The higher risk of the latter malignancy may be related to rheumatoid interstitial lung disease and immunosuppressive therapies. Herein we illustrate the case of a 59-year-old male smoker affected by RA and treated with cortisone, methotrexate and TNF-α antagonists, who underwent right lower lobectomy for a nodular lesion. On microscopic examination, the lesion consisted of two distinct areas: a central area of fibrinoid necrosis, bordered by histiocytes in a palisaded arrangement, lymphocytes and a 0.4 cm thick peripheral area constituted by a combined small cell anaplastic carcinoma, adenocarcinoma and squamous cell carcinoma. The combination of three histotypes is very rare in such a small tumour. In our case, it may be hypothesized that synchronous, heterogeneous mutations occurred in different type of committed cells or in stem cells, due to the production of cytokines by RA nodule histiocytes and lymphocytes, which are contiguous to the carcinomatous area. Since few studies have evaluated the topographic correlation between tumors and rheumatoid lung lesions, further morphological and molecular studies are needed to clarify this association and the pathogenetic relationship between RA and cancer of the lung.
authors.affiliation: Department of Human Pathology and Oncology, Anatomic Pathology Section, Siena University Hospital, Siena, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Spina
authors.forename: Maria Raffaella
authors.initials: MR
authors.lastname: Ambrosio
authors.forename: Bruno Jim
authors.initials: BJ
authors.lastname: Rocca
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Di Mari
authors.forename: Monica
authors.initials: M
authors.lastname: Onorati
authors.forename: Luca
authors.initials: L
authors.lastname: Luzzi
authors.forename: Irene
authors.initials: I
authors.lastname: Monciatti
authors.forename: Piero
authors.initials: P
authors.lastname: Tosi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D002277:Carcinoma / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D004396:Coloring Agents; D003348:Cortisone / Q000627:therapeutic use; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009336:Necrosis; D012218:Rheumatoid Nodule / Q000150:complications / Q000473:pathology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D004396:Coloring Agents; D014409:Tumor Necrosis Factor-alpha; D003348:Cortisone; D008727:Methotrexate