Anterior Mediastinal Mass in a Young Marijuana Smoker: A Rare Case of Small-Cell Lung Cancer
Jiten P. Kothadia
Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorSaurabh Chhabra
Division of Medical Oncology, Department of Medicine, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorAlan Marcus
Department of Pathology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorMichael May
Department of Pathology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorBiren Saraiya
Division of Medical Oncology, Department of Medicine, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorCorresponding Author
Salma K. Jabbour
Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorJiten P. Kothadia
Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorSaurabh Chhabra
Division of Medical Oncology, Department of Medicine, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorAlan Marcus
Department of Pathology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorMichael May
Department of Pathology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorBiren Saraiya
Division of Medical Oncology, Department of Medicine, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorCorresponding Author
Salma K. Jabbour
Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA umdnj.edu
Search for more papers by this authorAbstract
The use of cannabis is embedded within many societies, mostly used by the young and widely perceived to be safe. Increasing concern regarding the potential for cannabis to cause mental health effects has dominated cannabis research, and the potential adverse respiratory effects have received relatively little attention. We report a rare case of 22-year-old man who presented with bilateral neck lymphadenopathy, fatigue, and sore throat without significant medical or family history. The patient had smoked one marijuana joint three times a week for three years but no cigarettes. Chest CT demonstrated a large anterior mediastinal mass compressing the superior vena cava and mediastinal lymphadenopathy. A final diagnosis of small-cell lung cancer was reached. Although rare, a small-cell lung cancer in this patient should alert the physician that cannabis smoking may be a risk factor for lung cancer.
References
- 1 Berthiller J., Straif K., Boniol M., Voirin N., Benhaïm-Luzon V., Ayoub W. B., Dari I., Laouamri S., Hamdi-Cherif M., Bartal M., Ayed F. B., and Sasco A. J., Cannabis smoking and risk of lung cancer in men: a pooled analysis of three studies in Maghreb, Journal of Thoracic Oncology. (2008) 3, no. 12, 1398–1403, 2-s2.0-61449504527, https://doi.org/10.1097/JTO.0b013e31818ddcde.
- 2 Grendelmeier P., Cannabis and the lung—chill or kill?, Therapeutische Umschau. (2010) 67, no. 8, 427–430, 2-s2.0-77955301748, https://doi.org/10.1024/0040-5930/a000075.
- 3 Summary of the 2009 national survey on drug use and health, Journal of Pain & Palliative Care Pharmacotherapy. (2010) 24, no. 4, 434–438.
- 4 Voirin N., Berthiller J., Benhaïm-Luzon V., Boniol M., Straif K., Ayoub W. B., Ayed F. B., and Sasco A. J., Risk of lung cancer and past use of cannabis in Tunisia, Journal of Thoracic Oncology. (2006) 1, no. 6, 577–579, 2-s2.0-34247899107.
- 5 Aldington S., Harwood M., Cox B., Weatherall M., Beckert L., Hansell A., Pritchard A., Robinson G., and Beasley R., Cannabis use and risk of lung cancer: a case-control study, European Respiratory Journal. (2008) 31, no. 2, 280–286, 2-s2.0-39649085680, https://doi.org/10.1183/09031936.00065707.
- 6 Rickert W. S., Robinson J. C., and Rogers B., A comparison of tar, carbon monoxide and pH levels in smoke from marihuana and tobacco cigarettes, Canadian Journal of Public Health. (1982) 73, no. 6, 386–391, 2-s2.0-0020211004.
- 7 Tashkin D. P., Gliederer F., Rose J., Chang P., Hui K. K., Yu J. L., and Wu T. -C., Tar, CO and Δ9THC delivery from the 1st and 2nd halves of a marijuana cigarette, Pharmacology Biochemistry and Behavior. (1991) 40, no. 3, 657–661, https://doi.org/10.1016/0091-3057(91)90378-F.
- 8 Tashkin D. P., Smoked marijuana as a cause of lung injury, Monaldi Archives for Chest Disease. (2005) 63, no. 2, 93–100, 2-s2.0-23844510064.
- 9 Hart S., Fischer O. M., and Ullrich A., Cannabinoids induce cancer cell proliferation via tumor necrosis factor α-converting enzyme (TACE/ADAM17)-mediated transactivation of the epidermal growth factor receptor, Cancer Research. (2004) 64, no. 6, 1943–1950, 2-s2.0-1542510624, https://doi.org/10.1158/0008-5472.CAN-03-3720.
- 10 Fligiel S. E. G., Roth M. D., Kleerup E. C., Barsky S. H., Simmons M. S., and Tashkin D. P., Tracheobronchial histopathology in habitual smokers of cocaine, marijuana, and/or tobacco, Chest. (1997) 112, no. 2, 319–326, 2-s2.0-0030743078.
- 11 Gong H., Fligiel S., Tashkin D. P., and Barbers R. G., Tracheobronchial changes in habitual, heavy smokers of marijuana with and without tobacco, American Review of Respiratory Disease. (1987) 136, no. 1, 142–149, 2-s2.0-0023553511.
- 12 Barsky S. H., Roth M. D., Kleerup E. C., Simmons M., and Tashkin D. P., Histopathologic and molecular alterations in bronchial epithelium in habitual smokers of marijuana, cocaine, and/or tobacco, Journal of the National Cancer Institute. (1998) 90, no. 16, 1198–1205, 2-s2.0-0032547343.
- 13 Zhu L. X., Sharma S., Stolina M., Gardner B., Roth M. D., Tashkin D. P., and Dubinett S. M., Δ-9-tetrahydrocannabinol inhibits antitumor immunity by a CB2 receptor- mediated, cytokine-dependent pathway, Journal of Immunology. (2000) 165, no. 1, 373–380, 2-s2.0-0034235808.
- 14 Seo N., [email protected], Tokura Y., Takigawa M., and Egawa K., Depletion of IL-10- and TGF-β-producing regulatory γδ T cells by administering a daunomycin-conjugated specific monoclonal antibody in early tumor lesions augments the activity of CTLs and NK cells, Journal of Immunology. (1999) 163, no. 1, 242–249.
- 15 Huang M., Stolina M., Sharma S., Mao J. T., Zhu L., Miller P. W., Wollman J., Herschman H., and Dubinett S. M., Non-small cell lung cancer cyclooxygenase-2-dependent regulation of cytokine balance in lymphocytes and macrophages: up-regulation of interleukin 10 and down-regulation of interleukin 12 production, Cancer Research. (1998) 58, no. 6, 1208–1216, 2-s2.0-0032521401.
- 16
Melamede R. J., Cannabis and tobacco smoke are not equally carcinogenic, Harm Reduction Journal. (2005) 2, article no. 21, 2-s2.0-27744502258, https://doi.org/10.1186/1477-7517-2-21.
10.1186/1477?7517?2?21 Google Scholar
- 17 Ligresti A., Moriello A. S., Starowicz K., Matias I., Pisanti S., De Petrocellis L., Laezza C., Portella G., Bifulco M., and Di Marzo V., Antitumor activity of plant cannabinoids with emphasis on the effect of cannabidiol on human breast carcinoma, Journal of Pharmacology and Experimental Therapeutics. (2006) 318, no. 3, 1375–1387, 2-s2.0-33747624175, https://doi.org/10.1124/jpet.106.105247.
- 18 Munson A. E., Harris L. S., and Friedman M. A., Antineoplastic activity of cannabinoids, Journal of the National Cancer Institute. (1975) 55, no. 3, 597–602, 2-s2.0-0016804266.
- 19 Sasco A. J., Merrill R. M., Dari I., Benhaïm-Luzon V., Carriot F., Cann C. I., and Bartal M., A case-control study of lung cancer in Casablanca, Morocco, Cancer Causes and Control. (2002) 13, no. 7, 609–616, 2-s2.0-0036711775, https://doi.org/10.1023/A:1019504210176.
