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December 23, 1974

Gammopathy and Carcinoma

Author Affiliations

University of Cincinnati Medical Center Cincinnati

JAMA. 1974;230(12):1635-1636. doi:10.1001/jama.1974.03240120017008

To the Editor. —  This letter describes the clinical and laboratory findings in a patient with a hilar mass and persistent elevation of serum IgA fraction, but in whom biopsy specimens of the lesion were read as "reactive lymphoid hyperplasia." A pulmonary carcinoma was present at autopsy.

Report of a Case.—  A 60-year-old man was admitted in August 1972 because of weight loss, cough, and dyspnea. The physical examination, skin tests, and sputum cultures for fungi and tubercle bacilli were negative. The x-ray films showed a bilateral hilar mass; the skeletal surveys were normal. The symptoms improved; the patient was discharged, lost to follow-up, and seen in February 1973 with an increase in the hilar mass (Figure). Despite palliative treatment, he died in April 1973. At autopsy, bilateral hilar adenopathy and a necrotic adenocarcinoma in the bronchial glands of the right lower lobe were found. The tumor showed abundant secretory