Explosive multi-site metastasis temporally associated with acute exacerbation of idiopathic pulmonary fibrosis in a patient with surgically resected lung squamous cell carcinoma: a case report.

Junyi Mu, Yi Ding, Yunxia Yu, Rong Jiang, Zhijun Jie, Jingjing Feng

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Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Junyi Mu *Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.

Yi Ding *Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.

Yunxia YuDepartment of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.

Rong JiangDepartment of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.

Zhijun JieDepartment of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.

Jingjing FengDepartment of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.

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6 · The paper itself

Abstract

We report a rare case of a 78-year-old male with lung squamous cell carcinoma (SCC) and concurrent idiopathic pulmonary fibrosis (IPF) who underwent thoracoscopic partial left upper lobectomy and systematic mediastinal lymph node dissection. The tumor remained stable under regular surveillance for 13 months postoperatively. An acute exacerbation of IPF (AE-IPF) then occurred, resulting in severe hypoxemia. Although the patient's condition temporarily stabilized following antifibrotic therapy and high-flow nasal cannula (HFNC) oxygen therapy, explosive multi-organ metastases appeared within one year of AE-IPF onset, successively involving the liver, abdominal wall, and brain. The unique features of this case are: (1) a clinically "silent" interval of more than one year following curative surgery, after which severe systemic hypoxia accompanying AE-IPF was temporally associated with subsequent explosive tumor dissemination and is hypothesized to be a potential predisposing factor for rapid tumor spread; and (2) rare metastatic patterns for lung SCC, including in abdominal wall subcutaneous metastasis and suspected acral (digital) metastasis whose distinction from a primary trichilemmal carcinoma could not be definitively resolved. This case underscores the importance of early antifibrotic therapy to prevent AE-IPF, maintaining adequate oxygenation, and implementing comprehensive multidisciplinary surveillance for patients with lung cancer comorbid with IPF.

Indexed as

acute exacerbationhypoxiaidiopathic pulmonary fibrosislung squamous cell carcinomatumor metastasis

Identifiers

PMID42482911

DOI10.3389/fmed.2026.1874765

PMCPMC13385566

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