Metastatic lung tumor: report of two cases

We herein report 2 cases of metastatic lung tumor. The first case was a 59-year-old female, who had undergone a left radical mastectomy for the treatment of breast cancer 18 years before. She was found to have a pulmonary nodule in the left lower lobe on the routine chest radiograph. She underwent a video-assisted thoracic surgery (VATS) partial resection of the left lower lobe. Tumor was diagnosed as a lung metastasis of the breast cancer microscopically. The second case was a 77-year-old man, who had undergone a right nephrectomy for the treatment of renal cell carcinoma. He was found to have 2 nodules in the right lung (1 in the middle lobe and the other in the lower lobe) on the follow-up computed tomography (CT) scan of the chest. He underwent VATS partial resections of the right middle and lower lobes. While the tumor in the lower lobe was diagnosed as a lung metastasis of the renal cell carcinoma, the tumor in the middle lobe turned out a primary lung cancer.     

Experience of thoracoscopic extirpation of intrapulmonary lymphangioma

We report a 59-year-old woman who underwent thoracoscopic extirpation of the intrapulmonary cystic lymphangioma which was located in the subpleural space of the left upper lobe. A chest X-ray showed a solitary round nodule in the left pulmonary hilum. A computed tomography scan revealed a mass shadow at the interlobar region surrounding the interlobar pulmonary artery. A round nodule was recognized as low signal intensity on T1-weighted images by magnetic resonance imaging. There was biphasic signal intensity on T2-weighted images as well. Radiologically, we diagnosed this lesion as a benign cystic tumor in the lung. Thoracoscopic observation revealed a cystic lesion just beneath the visceral pleura of the upper lobe adjacent to the interlobular pulmonary artery. As this suggested a benign bronchogenic cyst, we performed extirpation of the cyst under thoracoscopy. After this operation, the cyst was diagnosed as an intrapulmonary cystic lymphangioma pathologically.     

Pulmonary metastasis of metachronous triple cancer occurring in a young patient

A 24-year-old patient who developed pulmonary metastasis of metachronous triple cancer was presented. She had undergone surgery and combined chemotherapy for osteosarcoma of the right humerus in 1993. Then, she was followed-up without any sign of recurrence. She felt accidentally a lump of the right breast so she had visited a hospital for a work-up in 2004. The detailed examination proved that the right breast mass was primary breast cancer so the right mastectomy was carried out. Moreover, the left mastectomy was also carried out for the primary breast cancer in 2005. Additionally, a solitary nodule shadow was detected by computed tomography in 2007 so she had thoracoscopic partial resection of right middle lobe. Histopathologically, the tumor was diagnosed metastasis from the left breast cancer. It is unlikely that familial cancer disease was the underlying cause because she had no family history of cancer. A more likely explanation is that there is the influence of combined chemotherapy during puberty.     

Thymoma with synchronous pulmonary metastasis; report of a case

We report a resected case of thymoma with a solitary pulmonary metastasis. A 63-year-old woman had pointed out a solitary nodule in right lung field on chest X-ray. Computed tomography (CT) scan showed an anterior mediastinal tumor and a solitary lung nodule in the right lower lobe. Extended thymectomy and partial resection of right lung was performed. Pathological diagnosis showed an invasive thymoma (type B3) and a pulmonary metastasis. Post operative radiotherapy was administered and she is doing well 19 months following the resection. Thymoma with a solitary synclonous pulmonary metastasis is rare and is classified into Masaoka stage IVb. Generally, thymoma cases with distant metastasis are not indication for operation. But, if radical resection is possible, operation is recommended for good prognosis.     

Adenoid cystic carcinoma of lower lobe of right lung: report of a case

A 69-year-old male was admitted to the hospital for further examination of an abnormal shadow in the right lower lung fields. He was previously under medical treatment for right thoracic empyema. Chest computed tomography (CT) showed a solitary mass, 4.5 cm in diameter and broncofiberscopy evidenced a tumor in the right lower bronchus. The biopsy was performed and the tumor was diagnosed as a pleomorphic adenoma. Intraoperativefinding showed the tumor was 6 cm in gross, extended to the left atrium, and a daughter tumor was palpable in the middle lobe. The middle and lower lobe were resected. The tumor was located in S9, S10, 6 x 4 x 3.5 cm in size, 2 daughter tumor was found in the middle lobe, the pulmonary vein was thickened by tumor invasion. Pathohistologically, main tumor and daughter tumor showed malignant feature, were compatible with adenoid cystic cancer. Four years after operation, he is still now alive with home oxygen therapy.     

Alveolar adenoma: an unusual lung tumor

A 34-year-old woman presented with chest pain and a solitary pulmonary nodule on chest roentgenogram. She was diagnosed with a rare benign lung tumor, alveolar adenoma of the lung, through pathological examination of the surgical specimen resected from the left upper lobe. Clinicians should also keep this entity in mind when making the differential diagnosis of a solitary pulmonary nodule.     

Comparison of the number of pre-, intra- and postoperative lung metastases.

AIM: To compare the number of lung metastases seen preoperatively on computed tomography in patients with a previous history of malignant disease with the number of resected pulmonary nodules and the number of histologically proven lung metastases. PATIENTS AND METHODS: Between 1998 and 2003, we operated on 281 patients with suspected lung metastases. The histology of the primary tumour, the number of preoperatively diagnosed nodules, the number of lesions removed during surgery and the number of histologically confirmed metastases of 276 patients are presented. RESULTS: Resection of lung metastases was performed in 276 patients. The median age was 62 years (21-86 years). The mean number of nodules seen on the CT scan was 1.9 (total: 515 nodules), 2.9 pulmonary lesions were removed (total: 835 nodules) and 2.1 nodules were confirmed as lung metastases (total: 560). In 39%, the number of lesions found and removed during the operation was higher than counted on the preoperative CT scan. These extra nodules found during the operation were confirmed as lung metastases in 16% of all patients. A benign solitary lesion was found in 15.2% of the patients and in 7.9% a primary carcinoma of the lung was diagnosed. In patients with a solitary nodule we found no metastasis in 16.4%, one lung metastasis in 76.7% and more than one lung metastasis in 6.9%. In patients with more than one nodule on the preoperative CT scan, an identical number of lung metastases were histologically confirmed in 35% of the patients, a larger number in 27.4% and a smaller number in 37.6%. CONCLUSIONS: In patients with a previous history of malignant disease, 15.2% of the pulmonary lesions are benign. Video-assisted thoracoscopic surgery (VATS) is a safe diagnostic and therapeutic method for solitary lesions, with little discomfort for the patient. In patients with more than one nodule on the CT scan, manual exploration of the lung is necessary to detect further lesions.     

18F-fluorodeoxyglucose positron emission tomography (FDG-PET) negative poorly differentiated adenocarcinoma of lung with mediastinal lymph node metastases

A 58-year-old woman was referred to our hospital for further medical examination of bilateral lung nodules on the chest computed tomography. Standardized uptake valve (SUV) max of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) were negative value at both lung nodules, but positive value (3.4) at a pretracheal lymph node. The size of the small lung nodule of the left lower lobe (S9) was unchanged, but the lung nodule of the right upper lobe (S1) was gradually enlarged. By the biopsy of the right lung nodule, the poorly differentiated adenocarcinoma was diagnosed pathologically. The right upper lobectomy with mediastinal lymph node dissection was performed. The metastasis was pathologically determined for FDG-PET positive lymph node. The most important reason for negative FDG-PET at primary lesion was considered that the expression of glucose transporter 1 (GLUT-1) was very few. FDG-PET has become a useful tool in the diagnosis of the pulmonary cancer, but we should understand its limitation and diagnose carefully.     

Metastasis of hepatocellular carcinoma to spleen and small intestine

Metastasis of cancer to the spleen or small intestine is rare. We encountered a case of hepatocellular carcinoma (HCC) with splenic and jejunal metastases. A 60-year-old man was referred to us in February 2005 with a diagnosis of splenic tumor. Since 2001, he had been treated repeatedly for HCC with liver cirrhosis due to hepatitis C virus infection; partial liver resection, transcatheter arterial chemo-embolization, and radiofrequency ablation therapy had been performed. In October 2004, he had undergone partial pulmonary resection due to metastasis of HCC to the lung. The splenic tumor, which was detected by computed tomography, seemed to be a metastasis of HCC. Splenectomy was performed for the splenic tumor, and a jejunal tumor was discovered and also resected. Both the splenic and jejunal tumors were diagnosed pathologically as metastases from the HCC. After repeated treatment for HCC, metastases can appear in various organs; thus, careful observation is necessary during follow-up.     

Splenic and Pulmonary Metastases from Renal Cell Carcinoma: Report of a Case

We report herein the case of a patient in whom pulmonary and splenic metastases from renal cell carcinoma (RCC) were successfully treated by surgical excision. A 69-year-old man who underwent left nephrectomy for RCC 17 months before was suspected to have a pulmonary metastasis based on computed tomography (CT) findings. Partial resection of the left lower lobe was performed with thoracoscopic assistance. However, 4 months later, a splenic tumor, 6 cm in diameter, was detected by CT and ultrasonography, and a splenectomy was performed. Histologically, both resected specimens were diagnosed as metastasis from RCC. A second pulmonary metastasis of the left upper lobe was resected 4 years 8 months later. The patient was in good health when last seen 11 months after his last operation. Malignant neoplasms rarely metastasize to the spleen and most cases are found at autopsy, or feature multiple distant metastases. Only four other cases of splenic metastases from RCC have been reported. The prognosis associated with splenic metastasis is favorable when only a solitary lesion exists. Received: February 4, 2000 / Accepted: November 20, 2000     

Recurrent breast cancer to the sternum 15 years after radical mastectomy and primary lung cancer; report of a case

We reported a successful operative case of solitary metastasis in the sternum 15 years after radical operation for a breast cancer and a primary lung cancer. The patient was a 59-year-old woman who was admitted for skin ulcer and tumor of the anterior chest wall. Histological diagnosis by skin biopsy was metastasis of breast cancer. Concurrently, chest computed tomography (CT) revealed a coin lesion with slight spiculation at the right lower lobe. Because histological diagnosis by the partial resection of the right lower lobe was primary lung cancer, we performed right lower lobectomy. Twenty-four days after the operation, subtotal sternal resection was carried out. She is alive and well without any complaints.     

25例脾脏肿瘤临床分析

目的 提高对脾脏肿瘤的诊治水平。方法 对25例脾脏肿瘤进行回顾性分析。结果 脾脏良性肿瘤病史一般超过半年,而恶性肿瘤则短于半年。B超首诊占40％(10/25),CT诊断的准确率超过B超,良性肿瘤13例行脾切除术,6例行脾部分切除术 脾移植。6例恶性肿瘤行脾切除术或广泛切除 化疗。25例脾切除术术后无一例死亡,亦未发现术后并发症。良性肿瘤全部治愈。恶性肿瘤3例,分别随访1年6个月,3年及3年8个月,患者仍然存活,失访3例。结论 原发性脾脏肿瘤在临床上罕见。良性肿瘤症状隐匿,病史长;恶性肿瘤病史短,伴有发热、消瘦、贫血。B超检查应作为首选方法。良性肿瘤尽量行保脾手术,恶性肿瘤行脾切除 化疗。     

Pulmonary pleomorphic carcinoma; report of 2 cases

The 1st case was a 74-year-old male diagnosed as femoral neck fracture. Biopsy of the bone revealed metastatic adenocarcinoma. Chest computed tomography (CT) showed a mass lesion located in the right lower lobe. With a diagnosis of primary lung cancer (cT2N1M1), two-staged operation was performed. Pathological diagnosis was pleomorphic carcinoma [pT2N1M1 (OSS), stage IV]. He died 8 months after surgery due to metastasis to the thoracic spine. The 2nd case was a 80-year-old female who complained of lateral chest pain. Chest CT revealed a tumor in the right hilar region, which was diagnosed as adenocarcinoma by transbronchial lung biopsy. Only thoracic drainage was performed since metastases to the brain and the rib were demonstrated. She died 2 months after admission. Autopsy revealed pleomorphic carcinoma of the lung with metastasis to the brain, costa and mediastinal lymph nodes.     

Small sclerosing hemangioma combined with primary lung cancer; report of a case

A 56-year-old woman underwent a surgery for right breast cancer when she was 51-year-old. In February 2002, computed tomography (CT) was performed as a part of a follow-up study and showed 2 small nodules in the lower lobe of her right lung: one was 10 mm nodule in S9, and another was 5 mm in S6. On a follow-up CT in March 2005, the S9 nodule had enlarged to 19 mm and was looked as ground glass opacity (GGO). We thought it was primary lung cancer. In contrast, the nodule in S6 had not enlarged and it was thought to be benign. In May 2005, right lower lobectomy was performed. The S9 nodule was diagnosed as adenocarcinoma, and the S6 nodule as sclerosing hemangioma.     

Solitary thyroid metastasis from colorectal cancer: Case report

Introduction and importanceThyroid metastasis of colorectal cancer is rare and the patient with thyroid metastasis has no symptoms early in the disease course. On the other hand, evaluation of thyroid is not generally included in the routine follow-up of colorectal cancer. Therefore, the diagnosis of thyroid metastasis of colorectal cancer may be delayed.Presentation of caseChest computed tomography revealed a nodule on the right lobe of the thyroid in 53-year-old woman diagnosed with sigmoid colon adenocarcinoma. This nodule was identified having as increased metabolic activity by ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography and confirmed to be consisted of cystic and solid portions by ultrasonography. Fine needle aspiration cytology of the nodule revealed metastasis of colon cancer. The patient underwent laparoscopic anterior resection and a total thyroidectomy. The size of the thyroid tumor was 1.2 cm with free resection margin.DiscussionThe clinical features of thyroid metastasis from colorectal cancer are not typical. In addition, follow-up examinations of patients with colorectal cancer do not include imaging studies of the neck, so the diagnosis of thyroid metastases is delayed. The management strategies for thyroid metastasis from colorectal cancer include a total thyroidectomy without prophylactic neck lymph node dissection and chemotherapy. However, as the penetration of chemotherapeutic drugs into the thyroid is difficult, the effect on the thyroid is considered insignificant.ConclusionSurgical treatment should be considered for treatment of thyroid metastasis.     

Endobronchial metastasis from adenocarcinoma of gastric cardia 7 years after potentially curable resection

Endobronchial metastasis (EBM) is a rare form of metastasis from extrapulmonary malignant tumors, although there are few reports of EBM from gastric cancer specifically. We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography. On diagnosis of primary lung cancer, she underwent pulmonary lobectomy, but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer. Six months later, she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen. She is still alive at 33 mo after the lobectomy. Generally, the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival. Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.     

The solitary pulmonary nodule in the patient with breast cancer

A solitary pulmonary nodule appearing in a patient with breast cancer, either past or present, is most likely to be a second primary cancer originating in the lung rather than a metastasis from the breast cancer. Between 1970 and 1983 there were at this institution 1416 patients with breast cancer and 579 patients with bronchogenic cancer, 198 of whom were women. Among the patients with breast cancer, 42 (or 3% of all of the patients with breast cancer) had a solitary pulmonary nodule either at the time of presentation of their breast cancer or during the follow-up period. Fifty-two percent of the solitary pulmonary nodules proved to be a primary lung tumor, 5% proved to be benign lesions, and only 43% proved to be metastatic breast cancer. Patients with breast cancer with solitary pulmonary nodules should have a diagnostic workup appropriate for lung cancer. Since adenocarcinoma has become the most common lung cancer cell type, the usual diagnostic tests may not allow a firm differentiation between primary lung and secondary breast cancer. Therefore if malignancy is proved or suspected, thoracotomy with appropriate resection is the treatment of choice in most patients with breast cancer, even at the initial appearance of the breast cancer.     

Pulmonary typical carcinoid tumor and liver metastasis with hypermetabolism on 18-fluorodeoxyglucose PET: a case report.

Pulmonary carcinoid tumors are generally hypometabolic on 18-fluorodeoxyglucose (FDG)-positron emission tomography (PET). We experienced a case of pulmonary typical carcinoid that showed rapid growth and high FDG uptake at the primary site and liver metastasis. A 56-year-old man with hemosputum had a medical examination by his family physician. A roentgenogram and computed tomography of the chest showed a solitary solid mass on the right lower lung field. However, he had not been shown an abnormal shadow on a roentgenogram taken 8 months earlier. He had undergone fiber-optic bronchoscopy, but the cytological diagnosis showed no evidence of malignancy. After that, FDG-PET was examined and revealed hot spots in the pulmonary tumor and liver mass. A standard uptake value of this pulmonary tumor was 32.9 mg/mL, and that of the liver mass was almost the same value of pulmonary lesion. He had undergone a right lower lobectomy diagnosed as a typical carcinoid. Thereafter he underwent partial resection of he liver mass, and the histology was metastasis from pulmonary carcinoid. We first reported a typical pulmonary carcinoid that showed high FDG uptake at the primary site and liver metastasis.     

Immunoglobulin G4-related inflammatory pseudotumor of the lung

A 61-year-old man was pointed out a solitary nodule located in the left lung (S9) measuring 18 × 29 mm in size along with lymphadenopathy by chest computed tomography (CT). Positron emission tomography( PET) scan showed a positive sign corresponding to the nodule[ standardized uptake value (SUV) max 5.8]. No diagnostic material was obtained from the transbronchial tumor biopsy, since it was difficult to rule out malignancy, surgical biopsy was performed with sampling of mediastinal lymph nodes. Histopathological examination showed marked infiltration of inflammatory cells, many of which were demonstrated to be immunoglobulin (Ig) G4-positive plasma cells by immunohistochemical staining. Hence, IgG4-related inflammatory pseudotumor of the lung was diagnosed.     

Outcome of surgical intervention for isolated intrathoracic lymph node metastasis from infradiaphragmatic malignancy: report of two cases.

We report 2 cases with isolated intrathoracic lymph node involvement. This is an unusual manifestation of metastatic spread from an extrathoracic malignancy. Case 1 was a 47-year-old female with a history of radical hysterectomy for cervical cancer of the uterus. Left intrathoracic lymphadenopathy was detected during follow-up. These lesions were surgically removed and diagnosed as multiple lymph node metastases. Two years later, right intrathoracic lymphadenopathy was evident and excised again. Eight months after the re-thoracotomy, retroperitoneal recurrence appeared and she died of the disease. Case 2 was a 41-year-old female with a history of resection of sigmoid colon cancer with liver metastases. A solitary nodule in the left upper lobe was shown by a chest computed tomography (CT). Left upper lobectomy was performed and the lesion was diagnosed as a solitary lymph node metastasis. She has had no recurrence for 3 years since thoracotomy.