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Left Lung Neoplasms and Bilateral Pleural Effusion Combined Elevated Carcinoembryonic Antigen in Pleural Effusion with Negative Result of Thoracoscopy Pleural Biopsy Misdiagnosed as Lung Carcinoma Ultimately Confirmed Pulmonary Sarcomatoid Carcinoma by CT-guided Percutaneous Lung Biopsy: a Case Report and Literature Review by Qian Zhang, Meng H. Wang, Wen Q. Li, Hong Y. Wang, Md Al-Masud Rana, Yi Chen, Cong H. Liu, Shuang Zhang, Yan X. Jin, Ci Zhang, Xiao Y. Zhu, Ai S. Fu, Yan L. Ge

Background: Detection of carcinoembryonic Antigen (CEA) in pleural effusion has good clinical application value in differentiating benign and malignant pleural effusion, but sometimes CEA provides limited help. We report a case of a patient with left lung neoplasms combined with bilateral pleural effusion with increased CEA in the pleural effusion whose thoracoscopy pleural biopsy pathology was negative, mimicking lung carcinoma and ultimately confirmed as pulmonary sarcomatoid carcinoma by CT-guided percutaneous lung biopsy.
Methods: The chest computed tomography (CT) scan, thoracoscopy pleural biopsy, and CT-guided percutaneous lung biopsy were arranged to explore the etiology of pleural effusion.
Results: The chest CT scan showed bilateral pleural effusion with left lung neoplasms, pulmonary atelectasis, and left hilar enlargement. Pathology of thoracoscopy biopsy showed pleural inflammation with infiltration of inflammatory cells. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary sarcomatoid carcinoma.
Conclusions: Elevated pleural effusion CEA is not a specific index of lung cancer. CT-guided percutaneous lung biopsy is appropriate for patients presenting with pleural diseases with lung neoplasms, especially when thoracoscopy pleural biopsy result was negative.

DOI: 10.7754/Clin.Lab.2019.190127