Pulmonary tumour with high carcinoembryonic antigen titre caused by chronic propolis aspiration

Carcinoembryonic antigen (CEA) titre elevation is sometimes found in benign diseases, such as gastro-intestinal tract inflammatory disease and chronic obstructive pulmonary disease; however, very high CEA titre is rarely encountered in benign pulmonary disease. A 36-yr-old female, who had suffered from body weight loss, was found to have high serum CEA titre (60.8 ng.mL(-1)). Image studies revealed one pulmonary tumour at the left lower lobe, satellite nodules and mediastinal lymphadenopathy. Left lower lobectomy and lymph node dissection were performed for suspicious pulmonary malignancy. The pathological examination revealed that the tumourous lesion was composed of small and fragmented foreign bodies, fibrinopurulent exudate and heavy eosinophils. The bronchial epithelium was characterised by goblet cell hyperplasia and CEA overexpression. The remaining lung parenchyma possessed similar foreign body reaction. The patient's medical history was reviewed and it was found that she had spread propolis topically on nasal mucosa as an adjuvant therapy to asthma for 6 months prior to this medical event. The CEA titre decreased after the operation to 14.2 and 7.88 ng.mL(-1) after 2 weeks and 6 months, respectively. Propolis is used widely in folk medicine but it also has strong sensitising potential. One rare case of propolis aspiration is reported with presentation mimicking lung cancer.