Mandibular metastasis in a patient with pulmonary adenocarcinoma

Metastatic tumour spread to the mandible is quite rare. We report a case of distant metastasis of pulmonary adenocarcinoma in the mandibular bone. The patient had pain in his left mandibular premolar-molar area caused by a mandibular metastasis from a previously undiagnosed pulmonary adenocarcinoma.     

<Superscript>18</Superscript>F-FDG PET/CT Imaging of Pulmonary Mucinous Cystadenocarcinoma with Signet Ring Cells

A 63-year-old male with a recently diagnosed right lung lesion was referred for staging. F-FDG PET/CT scan revealed a hypodense, cystic-like mass in the right upper lung lobe, which demonstrated low, diffuse ¹⁸F-FDG uptake, likely due to the presence of mucus, as well as intensely hypermetabolic right hilar and right paratracheal lymph nodes. Transbronchial biopsy revealed a primary pulmonary mucinous cystadenocarcinoma with the presence of signet ring cell carcinoma, a co-existence of two rare variants of lung adenocarcinoma. This case report demonstrates the metabolic phenotype along with the radiographic characteristics of this rare tumor and its metastases.     

Lung Adenocarcinoma Staged as an Unknown Primary Presenting with Symptomatic Colon Metastases: Staging by 18F-FDG PET/CT

A 66-year-old man, who presented with bright red blood per rectum, was referred for an ¹⁸F-FDG PET/CT after colonoscopy showed two suspicious colon masses, which were biopsied to reveal an adenocarcinoma of unknown origin. PET/CT showed two intensely FDG-avid colon masses as well as an unsuspected FDG-avid lung mass, which was biopsied to reveal a primary lung adenocarcinoma. Immunohistochemistry confirmed the two colon metastases were of pulmonary origin. It is extremely rare for lung carcinoma to present with symptomatic colon metastases, with only 11 cases described in the literature. We report the first case of the utility of ¹⁸F-FDG PET/CT in staging a patient who presented with symptomatic colon metastases of an unknown primary lung malignancy.     

Pulmonary Mucinous Cystadenocarcinoma: Report a Case and Review of CT Findings

A pulmonary mucinous cystadenocarcinoma is an extremely rare tumor that is considered to be a cystic variant of mucin-producing lung adenocarcinoma. We present a case of pulmonary mucinous cystadenocarcinoma in a 54-year-old woman. Chest CT scans showed a 4.3-cm-sized, lobulated, well-defined, and homogeneous mass in the right middle lobe with peripheral stippled calcifications that demonstrated low-attenuation with no enhancement after contrast administration; ¹⁸F-fluorodeoxyglucose (FDG) PET/CT demonstrated mild heterogeneous FDG uptake. The mass was diagnosed as adenocarcinoma with mucin production by transbronchial lung biopsy. Right middle lobectomy was performed, and the pathologic examination disclosed a pulmonary mucinous cystadenocarcinoma.     

Sudden death with clinically undiagnosed pulmonary hypertension

Four cases of sudden unexpected death associated with pulmonary hypertension are described. In all cases, the presence of pulmonary hypertension had not been clinically detected. In each case, the underlying etiology of the pulmonary hypertension was different with one case each of occult adult congenital heart disease, pulmonary sarcoidosis, pulmonary tumour microembolism from gastric adenocarcinoma, and familial primary pulmonary hypertension. These cases indicate that the forensic pathologist must be aware of occult pulmonary hypertension as a cause of sudden unexpected death in a variety of age groups.     

Well-differentiated fetal adenocarcinoma of the lung: early-phase sequential high-resolution computed tomographic findings

Well-differentiated fetal adenocarcinoma is a rare primary adenocarcinoma originating in the lung. We present an early phase case that was followed up for 2 years with chest roentgens and high-resolution computed tomography. Multicentric origin was suspected in the sequential high-resolution computed tomography study findings.     

Pulmonary infarction associated with bronchogenic carcinoma

Pulmonary infarction may be associated with bronchogenic carcinoma. Radiopathological correlation was performed in four patients. There were two cases of squamous cell carcinoma, one case of adenocarcinoma and one case of large cell carcinoma. Infarcts in patients with squamous cell carcinoma were obscured on plain radiographs by a large primary tumor or atelectasis of the affected lobe. Infarcts in adenocarcinoma and large cell carcinoma were clearly demonstrated on plain radiographs; 1 to 2 cm in size, round or polygonal in shape, blurred in margin, and located at the periphery of the same lobe as the primary tumor. Rapid appearance of infarcts was helpful in distinguishing from intrapulmonary metastasis. Invasion of the pulmonary artery, pulmonary vein and bronchial wall in hilar region was thought to be responsible for pulmonary infarction. Pulmonary infarct should be considered in patients with centrally invasive bronchogenic carcinoma, when a small ill-defined opacity appears at the periphery of the involved lobe over a short period.     

Subglottic carcinoma treated with surgery and adjuvant photodynamic therapy

Subglottic cancers are extremely rare as a primary malignancy representing <8% of all laryngeal cancers. Typical age at presentation is in the 5th decade. There are three main types of subglottic carcinoma: adenocarcinoma, mucoepidermoid and adenoid cystic carcinoma. We present a rare case of subglottic cancer treated with surgery and adjuvant photodynamic therapy.     

Multiple muscle metastases from lung cancer detected by FDG PET/CT

A 71-year-old man with right lung mass, who was recently diagnosed histopathologically with pulmonary adenocarcinoma, was referred for staging of the primary tumor. Whole-body F-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) demonstrated multiple hypermetabolic foci in various skeletal muscle localizations, suggesting extensive metastatic muscle involvements in addition to increased FDG uptake in the primary tumor. Subsequent biopsy and histopathological study confirmed muscle metastasis from lung adenocarcinoma. Skeletal muscle metastasis from lung cancer is rare, but multiple muscle metastases are even more unusual. FDG PET/CT is able to detect unexpected metastatic involvements such as multiple muscle metastases in lung cancer patients.     

FDG PET in the evaluation of the aggressiveness of pulmonary adenocarcinoma: correlation with histopathological features

2-[Fluorine-18]fluoro-2-deoxy-d-glucose (FDG) uptake within the primary lesion correlates with survival on positron emission tomography (PET) studies of patients with non-small cell lung cancer. The more metabolically active the tumour, the worse the outcome. The aim of this study was to determine whether a correlation exists between aggressiveness as determined by pathology and the findings of FDG PET in pulmonary adenocarcinoma. Thirty-five patients with 38 adenocarcinomas of the lung were studied. All patients underwent thoracotomy within 4 weeks of the FDG PET study. For semiquantitative analysis, standardized uptake values (SUVs) were calculated. Patients were classified into high SUV (> or = 4.0) and low SUV (<4.0) groups. The degree of FDG uptake (SUVs) in primary lung lesions was correlated with the histopathological features of aggressiveness (pleural involvement, vascular invasion or lymphatic permeation). The mean SUV of aggressive adenocarcinomas (4.36+/-1.94, n = 22) was higher than that of non-aggressive ones (1.53+/-0.88, n = 16) (P < 0.0001). Tumours with a high FDG uptake have a significantly higher likelihood of aggressiveness than those with a low FDG uptake (P = 0.0004). Analysis by the Kaplan-Meier methods revealed that the groups had different prognoses (log-rank test, P = 0.0099). The high SUV group had a significantly worse prognosis. In conclusion, a correlation was seen between aggressiveness as determined by pathology and glucose metabolism as measured by FDG PET in adenocarcinoma of the lung. FDG PET may be used as a non-invasive diagnostic technique in measuring aggressiveness and prognosis in patients with pulmonary adenocarcinoma.     

An autopsy case of sudden death in a boy with primary pulmonary hypertension: a case report

We report a rare autopsy case of sudden death due to primary pulmonary hypertension. A seven-year-old boy, who had been diagnosed with primary pulmonary hypertension at the age of four years, died suddenly. Forensic autopsy and histopathologic examination revealed extensive obstruction of small muscular pulmonary arteries by plexiform lesions and concentric intimal thickenings, compatible with primary pulmonary hypertension. We concluded that plexiform lesions of pulmonary arteries produced right ventricular hypertrophy and dilatation, decreased the preload of the left ventricle and subsequently led to biventricular failure. This autopsy and histopathologic examination suggested a possible pathophysiologic mechanism of sudden death due to primary pulmonary hypertension in a child.     

Metastatic acinar cell carcinoma of the liver from a benign-appearing pancreatic lesion: a mimic of hepatocellular carcinoma

Acinar cell carcinoma (ACC) is a rare pancreatic tumour with a favourable prognosis compared with the more common ductal adenocarcinoma. The radiological findings of this tumour have been described in the literature; however, only limited data are available regarding the metastatic features of ACC of the liver, the most common metastatic site. We report a case of ACC of the pancreas with a hepatic metastasis from a benign-appearing malignant pancreatic lesion.     

70岁以上慢性阻塞性肺疾病患者肺部真菌感染临床观察

目的探讨70岁以上慢性阻塞性肺疾病(COPD)患者肺部真菌感染的病原学、易感因素及预后。方法对68例70岁以上COPD合并真菌感染患者的病原学、易感因素及预后进行分析,并与无COPD的76例肺部真菌感染患者进行比较。结果两组患者病原菌均以酵母菌属为主。COPD、年龄、长期应用糖皮质激素及抗生素、糖尿病对肺部真菌感染有影响,两组比较差异有统计学意义(P<0.05)。结论酵母菌属是肺部真菌感染主要致病菌。70岁以上COPD患者合并肺部真菌感染病情重,病程长,病死率高。     

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) masquerading as metastatic carcinoma with multiple pulmonary deposits

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary disorder presenting with multiple pulmonary nodules in association with a typical mosaic perfusion pattern on computed tomography. In this case, the absence of mosaic perfusion led to an erroneous initial diagnosis of pulmonary metastases from an unknown primary malignancy. This illustrates the importance of considering differential diagnoses when presented with imaging findings compatible with pulmonary metastases from an unknown primary, and highlights the importance of histopathologic confirmation in such cases.     

Cardiac metastasis: a cause of recurrent pulmonary emboli

Intracavitary cardiac metastasis is rare. Apart from causing intracardiac obstruction, this type of metastasis can present as pulmonary emboli. It is important to suspect this diagnosis in an oncology patient with recurrent pulmonary emboli, particularly in the setting of a negative venous Doppler ultrasound of the lower limbs and pelvis. Early recognition may help in improving the prognosis. We present a case of intracavitary cardiac metastasis arising from a squamous carcinoma of the cervix, in a patient with recurrent pulmonary tumour emboli.     

Maligne Lungentumoren im Kindesalter

Pulmonary neoplasms in children are rare. The majority of tumors involving the respiratory system are metastatic and primary lung tumors are even more rare. Approximately 75% of primary lung tumors are malignant, the most frequent of which are adenoma, bronchogenic carcinoma, and pleuropulmonary blastoma. Due to the rarity of these malignancies, and the usually nonspecific clinical symptoms, they are often not considered in the differential diagnosis in children who present with persistent pneumonitis, coughing, and atelectasis. This often results in delayed definitive treatment and, in general, a worse prognosis. The role of the radiologist is that by using modern imaging techniques, to facilitate early recognition and staging, enabling adequate treatment and follow-up and thus, a better clinical prognosis. This article provides an overview of the most relevant entities of primary childhood pulmonary malignancies, with a particular emphasis on the imaging characteristics.     

A case of metastatic bone tumor of missed lung cancer showing unusual manifestations on chest radiogram

We encountered a patient who had a primary unknown carcinoma with lumbago caused by lumbar vertebral metastasis as the initial chief complaint. Autopsy revealed primary pulmonary adenocarcinoma. Abnormal findings noted on plain chest radiogram and chest CT led to misdiagnosis as inflammatory changes. The primary lesion was poorly differentiated pulmonary adenocarcinoma that could not be diagnosed correctly using the diagnostic criteria of these diagnostic modalities.     

Myofibroblastic inflammatory tumor of the lung

Myofibroblastic inflammatory tumor is a controversial entity that shows great variability in clinical presentation, histological findings, evolution, and prognosis. It is a rare cause of primary lung tumor in adults; however, it is the most common cause of lung tumors in children. The diagnosis is fundamentally histological, although histological diagnosis is not easy because myofibroblastic inflammatory tumor is characterized by a polymorphic cellular infiltration of variable cellular composition that could be similar to other diseases such as lymphoma or low-grade sarcoma. We report the case of a 23-year-old woman in whom a solitary pulmonary nodule was discovered incidentally at plain-film chest x-ray.     

原发性肺动脉肿瘤的影像学诊断

目的：探讨原发性肺动脉肿瘤临床及影像学特点。方法：对3例经手术、病理证实的原发性肺动脉肿瘤（良性间叶细胞瘤、恶性间叶细胞瘤及纤维肉瘤各1例）进行回顾性分析。3例均经胸部X线平片、电子束CT（EBCT）、核素肺灌注显像、超声心动图及肺动脉造影进行检查。结果：2例EBCT检查作出正确诊断，其中1例其他影像学检查均考虑肺动脉栓塞；另1例所有影像学检查均误诊为肺动脉栓塞。结论：原发肺动脉肿瘤非常少见，临床无特异性，诊断困难。X线平片、CT及肺动脉造影均有其相应的征象，但均为非特异性，综合影像学检查是必要的。