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Male, 63 years old, bilateral lung metastases
Positive and lateral chest x-rays
Axial CT scan of the chest
What is the most likely primary tumor?
1.
Glioblastoma multiforme
2.
Small cell lung cancer
3.
Prostate cancer
4.
Esophageal cancer
5.
Pancreatic cancer
【Answer】
4.
Esophageal cancer
【Discussion】
Cavitary lung metastases
【Overview】
1.
About 30% of metastases of malignant diseases occur in the lungs
2.
Transmission routes include hematogenous, lymphatic metastasis and direct spread
3.
Most metastatic pulmonary nodules metastasize by hematogenous dissemination
4.
Cavitation in primary lung cancer is more common than metastatic lung lesions
5.
The primary focus of most cavitary metastases is epithelial
6.
Squamous cell carcinoma is the most common cavity-forming metastases (70%), especially head and neck tumors
7.
Pulmonary lymphoma rarely forms cavities and is often accompanied by lymphadenopathy
【Clinical manifestations】
1.
It can be asymptomatic, especially slow-growing malignant tumors, such as: papillary thyroid carcinoma or salivary glandoid cystic carcinoma
2.
The late stage of cancer is often advanced/end-stage malignant tumor and the symptoms and signs associated with the primary tumor dominate
【Imaging findings】
1.
Chest x-ray is usually the preferred test for finding lung metastases
2.
CT scan has higher resolution than X-ray and can show more and smaller nodules
3.
Plain x-rays found cavitation of lung metastases in 4% of cases
4.
There are many metastases
5.
Metastases often vary in size, indicating that the time of tumor embolism is different
6.
Cavitary metastases have thick and irregular walls
7.
Parenchymal cavities can be seen in metastases of adenocarcinoma and sarcoma
8.
Cavitation formation of upper lobe lesions is more common than in lower lobes
【Differential diagnosis】
1.
Tuberculosis (TB)
2.
Rheumatic nodules
3.
Necrotizing granulomas
【Treatment】
1.
For disseminated tumors, chemotherapy is a commonly used treatment
2.
Performing lung metastases resection depends on the relevant primary malignancy and surgical selection criteria
【Prognosis】
1.
The presence of lung metastases is an indicator of poor prognosis and indicates disseminated disease
2.
Mortality depends on the primary tumor
Cavitary lung metastases:
Positive and lateral chest x-rays (above) show multiple masses
in both lungs.
Cavitation
is visible in at least one mass in the left lung (white arrow).
Axial CT scan of the same patient shows multiple masses, two of which show significant cavitation (white arrows)