MULTIPLE LUNG NODULES AND AN UNCOMMON FINDING: TWO DISTINCT PULMONARY METASTASIS

Abstract

TOPIC: Lung Cancer TYPE: Global Case Reports INTRODUCTION: The solitary lung nodule is a classical entity usually described under solid guidelines and strong scientific evidence, with well-known management and follow-up. However, dual or multiple pulmonary nodules might be a propedeutic challenge, although they are usually linked to a single nosological agent and when related to a tumoral origin are habitually provenient from breast, colorectal, renal cell, head and neck cancer. More uncommon primary tumors with frequent lung metastasis are pancreatic, testicular and thyroid cancer followed by osteosarcoma. This case report demonstrates the management of a patient with double main pulmonary nodules with distinct causes. CASE PRESENTATION: A 69 year old, non-smoker male patient from Rio de Janeiro, Brazil presented on a scheduled follow-up for a nephrectomy in 2009 caused by a renal clear cell carcinoma with a chest tomography with two lung nodules in lingula, both measuring about 1,5 cm and clinically asymptomatic. Further investigation revealed nodule enlargement but low avidity on PET-CT 2 months later. Patient underwent exploratory thoracotomy and lobectomy which revealed both nodules to be a clear renal cell carcinoma metastasis, but surprisingly, a third nodule of 1,5 mm was found on the procedure and consisted of a papillary thyroid carcinoma. On sequence, in 2021 his thyroid was surgically removed, revealing a malignant nodule, corroborating the previous diagnosis. DISCUSSION: Thyroid cancer is the most common subsequent tumor related to a previous renal cell carcinoma and some scientific research proposes a BRAF mutation being linked to this finding. That being said, renal cell carcinoma has as risk factor a history of thyroid carcinoma. Being both tumors with slow onset and poor clinical presentation and low metabolic profile, they are usually difficult to diagnose at early stages. CONCLUSIONS: This case demonstrates that a high suspicion level and thorough management can achieve reasonable levels of diagnosis and high survival rates even when two rare entities are bound in the same case. REFERENCE #1: Immunotargets Ther . 2013; 2: 73 90. Jul 22 REFERENCE #2: Thyroid cancer : Coexisting papillary thyroid carcinoma and renal cell carcinoma: 4 cases ( Mehmet Celik1, Semra Ayturk1, Buket Yilmaz Bulbul1, Nuray Can2, Ebru Tastekin2, Atakan Sezer3, Funda Ustun4 & Sibel Guldiken1) : Endocrine Abstracts (2016) 41 EP1146 DISCLOSURES: no disclosure on file for Barbara Bracarense; No relevant relationships by Michelle Cailleaux-Cezar, source=Web Response No relevant relationships by Fábio Kunita, source=Web Response