Unable to diagnose Lungs problem - Pls help

[munkut]

My mother was diagnosed with oral cancer last year – she had surgery of her right mandibles in March 08 followed by 6 weeks of radiation. However, 10 weeks back she caught a severe cold that rapidly developed into persistent wheezing and coughing. She has fever almost every day. CT scan revealed a “nodule” in her lungs. The report says “right hilar soft tissue mass with perilesional nodules and patchy consolidations with ipsilateral minimal pleural effusion”.

Her biopsy did not find any malignant cells. The pleural fluid analysis showed Lymphocytes = 95%. TB test came back negative. Her symptoms are getting worse every day (especially after the biopsy/pleural aspirations, her body is aching a lot). Could anybody please comment on her symptoms?

Current Symptoms

Weight loss: Yes - may be attributed to her earlier cancer.
Fatigue:  Yes
Fever: Yes - once everyday upto 100 degrees
Night sweats: Yes - mostly in forehead
Chills: Yes
Loss of appetite: Yes
Chest pain: Yes
Shortness of breath: Yes
Dry cough: Yes - Blood seen 4 times in 2 months
Swelling of lymph nodes: None visible
Itching: No
Abdominal pain/swelling: No

Tests done

Tuberculosis: Negative

Pleural Fluid Analysis
Color: Straw
Appearance: Turbid
Coagulum: Absent
Sugar: 87 mg/dl
Protein: 3.8 gm/dl
Polymorph Neutrophils: 5%
Lymphocytes: 95%
Report Smear from centrifuged deposit show lymphocytes, macrophages few mesothelial cells and some cells clusters with suspiscious morphology.

PF & PV: Negative
ESR: 100 mm AEFH

Cytopathology
(Righ lung mass) haemorhagic and necrotic background, many neutrophils, lymphocytes, macrophage and benign looking bronchial cells. No definite granuloima/malignant cells seen.
(Bronchial Brushing) necrotic and inflammatory background, discrete and clusters of benign looking bronchial cells only. No granuloima or malignant cells seen.

Blood Test
WBC count: 9500 per cu mm
Neutrophil%: 80
Lymphocite%: 14

Thanks!

[SusieQ2u]

Walking a similar road and hoping to help ... My beautiful mother was diagnosed with sjogren’s syndrome about 1970 and cancer (2005 & again 2008).  Since December 2005 has had two major surgeries and lost most of the left side of her face inside (including jaw bone) with a rare double squamacell, form of cancer (she never smoked & never used alcohol).  Cancer projected likely to return, but is clear margined at this time.  She had a muscle flap reconstruction which did not do what was hoped but has helped in keeping her face as normal as possible.  The remaining jawbone still swings and causes pain on opposite side.   Additionally had three back surgeries for rupture and deterioration of discs between L2 and L5.  Is now completely on a feeding tube (forever) though NOT bedridden and is living at home or with daughter (me).  She stills trys to drink Boast from her glass with a straw to keep muscle going ... when she can.  Feeds and medicates herself and when not down in her back is able to function in nonabrasive daily activity such as walking …etc.  Wishes to be more active at only 74 years old.  We understand and quickly realize that every doctor we see has little experience with combinations presented herein.  
Now, about every three months we go through 'bouts of so called pneumonia, or are treated as if she has COPD (which she does not)….she lost salivary glands in surgery ... because her body does not take care of enough sinus type secretions, which eventually solidify, coating the bronchi tubes and some ending up as “trash” in the lungs.  This leads to asthmatic type breathing and or bacterial type lung infections.  Of course, they have each time treated her with hospitalization and quad IV antibiotics.  Lately the best thing that has happened is that a university team has suggested a new revamped medication program geared toward “non-drying” drugs and nothing in the lungs except moisturizing type meds.
They dropped Norpace which was for a heart rhythm problem … she had taken for over 20 years … does not seem to have rhythm problem any more and Norpace was old and drying.  They have added two nebulizer style meds, which have to be taken in completely separate cup treatments … Perforomist & Pulmicort.
She has a Primary Care doctor, Otolaryngologist cancer doctor, Neurologist doctor, new Pulmonary doctor, Spinal doctor, and has seen on occasion a – Cardio doctor, Rheumatologist, Dermatologist, and Allergist.  She is exhausted in seeing so many with so many trips to same.  We are trying to find best balance and least medicated care program.  She remains with chronic pains including backaches and permanent radiation damage, whereby her mouth breaks out in blisters and pain every few weeks.   We feel we have come a long way and are still "finding our balance" in trying to identify the right med for depression (Paxil is current but drying) and trying to decide if the breathing meds are part of the blistering problem.  
I am just saying to you ... think "Moisturizing" in every decision you make as oral cancers and all their meds tend to dry out normal sinus functions and lungs.  Good Luck to you and yours in finding your "BALANCE" as it is a very individual thing!

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
With a history of prior head/neck malignancy and current symptoms and imaging results, the number one priority is to rule of cancer metastases.
Even if bronchial wash and FNAC are negative, it does not definitely rule out cancer (sampling error etc).
One way to quickly narrow down the possibilities is to get a PET-CT done. An interventional radiologist could be at hand for performing a CT-guided FNAC/biopsy at the same sitting.
All the best and God Bless!