Lung cancer in patients with scleroderma-associated interstitial lung disease: Case series and implications for screening.

Objective: Patients with scleroderma associated interstitial lung disease (SSc-ILD) are at an increased risk for lung cancer, necessitating a high index of suspicion for timely detection. This case series describes three patients with SSc-ILD who developed lung cancer, highlighting diagnostic and therapeutic challenges in detecting and managing malignancy within abnormal lung parenchyma. Methods: Electronic medical records were reviewed by a team of physicians. Clinical, radiographic, and pathologic data from each patient's disease course were synthesized to illustrate diagnostic workup and management decisions. Results: The series includes two former smokers with minimal smoking history and one never-smoker. Lung cancer stages at diagnosis ranged from IA to IVb. Positron emission tomography imaging was instrumental in raising suspicion for malignancy and selecting diagnostic sites. Pausing immunosuppression led to ILD progression for all patients. Conclusion: This case series emphasizes the importance of maintaining a high index of suspicion for lung cancer in patients with SSc-ILD, including among minimal or non-smokers, and highlights the urgent need for future research into risk factors and mechanistic pathways, screening strategies, and management approaches for lung cancer in SSc-ILD.