Diagnosis Of Pulmonary Metastases Research Articles

Radiomics Model for Predicting Pulmonary Metastasis in Sarcoma Patients

The lung is the most common site of metastasis in localized extremity soft tissue sarcomas (STS). Indeterminant lung nodules leads to challenges for both patients and providers. As such, accuracy in the diagnosis of pulmonary metastasis (PM) is important for clinical decision making. The purpose of this is study is to develop and evaluate a CT-based radiomic model to predict PM in sarcoma patients with indeterminate pulmonary nodules. Fifty-seven stage I-III sarcoma patients with indeterminate lung nodules on unenhanced CT that were approved for this study by our institution's internal review board (IRB). Twenty-two developed and categorized as PM and 35 without PM. A total number of 322 indeterminate nodules were investigated, where 165 & 157 nodules were from patients with and without PM, respectively. A total of 96 radiomic features (RF) (including first order statistics, 2d shape features, gray level co-occurrence, gray level size zone, gray level run length, neighboring gray tone difference & gray level dependence matrices) were taken from unenhanced CT images of each patient. We included 2D shape features since the size and shape of indeterminate lung nodules may have some correlation with PM. Spearman correlation were used to rule out redundant features (r2>0.9). T-test statistics was used to determine feature with significant differences that can differentiate responders with and without PM. Support Vector Machine (SVM) model was fitted to combinations of groups of 2-3 radiomic features. The AUC of the ROC curve was used to evaluate the model performance. Pointwise confidence intervals (CI) for AUC were calculated using 100 bootstrap replicates. Four features were found significant after Spearman correlation and T-test statistical testing: 1. Maximum (MAX); 2. Minor Axis Length (MAL); 3. Gray Level Non-uniformity (GLNU); and 4. Interquartile Range (IR). The best performing 2-feature radiomic SVM model had an AUC of 0.69 (95% CI 0.61,0.74) for the MAX and GLNU features. The best performing 3-feature radiomic SVM model had an AUC of 0.74 (95% CI 0.70,0.80) for the MAX, MAL and IR features. CT-based radiomics model has the potential to be used to predict PM in sarcoma patients presenting with indeterminate lung nodules. Additional research will focus on investigating derived parameters for existing RF, such as the ratio of the max RF to mean RF, to see if they improve the predictive performance of the model, as well as testing the models on external patient cohort. These radiomic models could be useful tools in guiding PM screening and providing a patient specific monitoring of sarcoma patients.

Prognostic Factors for Leiomyosarcoma with Isolated Metastases to the Lungs: Impact of Metastasectomy

BackgroundLeiomyosarcoma (LMS) most frequently metastasizes to the lung. Metastatic LMS is considered incurable. Selected patients may benefit from pulmonary metastasectomy (PM) within multimodal therapy. This study analyzed the prognostic relevance of clinicopathologic factors in these patients.MethodsPatients with metastatic LMS to the lung treated in our center from 2004 to 2020 were included in this single-center retrospective study. Overall survival (OS), progression-free survival (PFS), and prognostic factors were analyzed.ResultsThe study had 64 patients (33 males, 52%) with metastatic LMS to the lung. The 5-year OS was 55% after the diagnosis of pulmonary metastases. Age older than 60 years at the primary tumor diagnosis, primary tumor larger than 70 mm, and five or more lung metastases were associated with poorer OS. Of the 64 patients, 44 underwent PM. The postoperative mortality rate was 0%. The patients selected for PM were younger and had smaller primary tumors, fewer metastases, and metastases that more often were metachronous. Metastasis grade (G1 vs. G2/3) and size (20-mm cutoff) were significant prognostic factors for OS (p = 0.05) and PFS (p = 0.028) after PM, respectively. The 44 patients who underwent PM had a survival benefit compared with the patients who were selected but did not undergo PM (n = 6) and the patients who were not selected for PM (n = 14). Three patients (7%) were alive and free of disease at the last follow-up visit respectively 5.5, 9, and 12 years after PM.ConclusionsFor patients with leiomyosarcoma, PM is safe. Despite aggressive multimodal treatment, most patients will experience recurrence and eventually die of their disease. However, a small subgroup of patients could potentially be cured after PM.

The diagnosis of pulmonary metastases on chest computed tomography in primary bone sarcoma and musculoskeletal soft tissue sarcoma

The lungs are the commonest site of metastasis for primary high-grade bone and soft tissue sarcoma, but current guidelines on the management of pulmonary nodules do not specifically cater for this group of patients. The current article reviews the literature from the past 20 years that has reported the CT features of pulmonary metastases in the setting of known primary bone and soft tissue sarcoma, with emphasis on osteosarcoma, chondrosarcoma, and trunk and extremity soft tissue sarcoma, the aim being to aid radiologists who report chest CT of musculoskeletal sarcoma patients in deciding which lesions should be considered metastatic, which lesions are indeterminate and require follow-up, and which lesions are of no concern.

Metastases of Urothelium Carcinoma: Differential Diagnosis, Resection, and Survival.

Due to its very aggressive nature and low survival chances, the metastasized urothelium carcinoma poses a challenge in regard to therapy. The gold-standard chemotherapy is platinum based. The therapy options are considered controversial, including new systemic therapies. In this respect, surgical therapies, as already established for pulmonary metastases of other tumor entities play an increasingly important role. The consumption of nicotine is a risk factor not only for urothelium carcinoma but also for a pulmonary carcinoma. Thus, we examined the frequency of a second carcinoma in this cohort. We retrospectively examined patients who had a differential diagnosis of pulmonary metastases, as well as those patients who underwent a surgery due to pulmonary metastases of a urothelium carcinoma between 1999 and 2015. A total of 139 patients came to our clinic with the differential diagnosis of pulmonary metastases of a urothelium carcinoma. The most common diagnosis was pulmonary carcinoma (53%). Thirty-one patients underwent surgeries due to pulmonary metastases of a urothelium carcinoma. The median survival was 53 months and the 5-year survival was 51%. With the univariate analysis, only the relapse-free interval of more than 10 months was statistically significant (p < 0.001). There is a high coincidence of urothelial carcinoma and lung carcinoma. A histological confirmation should be endeavored. Selected patients undergoing a pulmonary metastasis resection have a survival advantage during the multimodal treatment of pulmonary metastasized urothelial carcinomas. For a definitive recommendation, randomized trials including a uniform multimodal therapy regimen and higher numbers of patients are necessary.

Exploration of clinicopathologic factors associated with postoperative pulmonary metastasis in elderly patients with rectal cancer

Objective To investigate the incidence rate, timing and risk factors of metachronous pulmonary metastasis after curative resection in patients with rectal cancer. Methods A total of 198 patients with rectal cancer undergoing curative resection in gastroenterology surgery department of Beijing Hospital from 2007 to 2012 were enrolled in this retrospective study.The metachronous metastasis and recurrence were observed.Clinicopathologic factors which might be associated with postoperative pulmonary metastasis were analyzed by the univariate and multivariate analysis. Results The 5-year disease-free survival was 76.8% in a total of 198 patients cohort.The most frequent metastatic sites were the lung(incidence of 11.6%)followed by liver(7.6%). Median interval from rectal surgery to diagnosis of pulmonary metastasis was much longer than that of hepatic metastasis(19 vs.11 months, P=0.002). Tumor location, current tumor-node-metastasis(TNM)stage, and a positive circumferential resection margin(CRM)were identified as the independent risk factors for pulmonary metastasis.The most common metachronous metastasis site for rectal cancer after curative surgery was the lung in elderly patients. Conclusions The lung is the most common metachronous metastatic site after curative surgery of rectal cancer in elderly patients.For patients with unfavorable risk profiles, a more intensive surveillance program is needed for the early detection of metachronous metastasis and recurrence. Key words: Pulmonary metastasis; Rectal cancer; Postoperative follow-up

Diagnostic value of therapeutic dose 131I-SPECT/CT fusion imaging for the postoperative pulmonary metastasis of thyroid carcinoma

Objective To explore diagnostic value of therapeutic dose 131I-SPECT/CT fusion imaging (Rx 131I-SPECT/CT) for the pulmonary metastasis of postoperative thyroid cancer, and to compare with therapeutic doses 131I-whole body scan (Rx 131I-WBS). Methods The Rx 131I-WBS and lung Rx 131I-SPECT/CT findings in 18 patients who were suspected pulmonary metastasis of postoperative thyroid cancer with serum thyroglobulin (Tg) levels increased were retrospectively analyzed on the CT features and the iodine intake degree of the pulmonary lesions. The accuracy and the incremental value of the diagnosis for pulmonary metastases by Rx 131I-WBS and lung Rx 131I-SPECT/CT were compared. Results Among 18 patients, 15 cases pulmonary metastasis of postoperative thyroid carcinoma were confirmed by the final clinical diagnosis and follow-up. 12 cases, 5 cases and 1 case were diagnostic accuracy, false positives, and false negatives by Rx 131I-WBS, respectively, and 18 cases, 0 case and 0 case by Rx 131I-SPECT/CT, respectively. The diagnostic accuracy rates of Rx 131I-WBS and Rx 131I-SPECT/CT were 66.7 % (12/18) and 100 % (18/18), respectively (P < 0.05). In 15 patients with pulmonary metastasis, serum thyroglobulin (Tg) was (541.5±274.3) ng/ml, and 30 and 46 pulmonary metastases were found by Rx 131I-WBS and Rx 131I-SPECT/CT, respectively. 5 and 7 pulmonary lesions were found by Rx 131I-WBS and Rx 131I-SPECT/CT in 3 cases of pulmonary non-metastases, respectively. The mean degrees of iodine intake in pulmonary lesions were (368.25±354.31) kBq and (5.87±6.97) kBq in 15 patients with pulmonary metastasis and 3 patients without pulmonary metastasis, respectively. Conclusions Rx 131I-SPECT/CT fusion imaging has a high identification accuracy for the diagnosis of pulmonary metastasis of postoperative thyroid carcinoma, featured by the better localization and qualitative diagnosis compared with 131I-WBS, and it could detect occult lesions to provide the degree of iodine intake and the morphology of lesions. Lung Rx 131I-SPECT/CT plays an important role in the disease assessment and postoperative stage for the elevated serum Tg or uncertain localization of pulmonary lesions by Rx 131I-WBS in thyroid carcinoma postoperative patients. Key words: Tomography, emission-computed, single-photon; Computed tomography; Thyroglobulin; Thyroid neoplasms; 131I therapy

Isolated pulmonary metastases define a favorable subgroup in metastatic pancreatic cancer

PurposeLiver metastasis represents the first site of dissemination in >80% of metastatic pancreatic cancer (PC) patients. Pulmonary metastasis as first site of dissemination in PC is a rare event and might define a biologically distinct subgroup in metastatic PC. MethodsConsecutive PC patients who were diagnosed or treated with isolated pulmonary metastases at our high-volume comprehensive cancer center were included in a prospectively maintained database between 2002 and 2015. Medical records and correlating computed tomography findings (CT) were retrospectively analyzed. ResultsA total of 40 PC patients with isolated pulmonary metastases were identified. Pulmonary metastases represented disease recurrence after initial resection of PC in 22 patients and disease progression of locally advanced pancreatic cancer in 5 patients. 14 out of 27 PC patients (56%) had received chemoradiotherapy for localized disease prior to pulmonary metastasis. Data on 1st-line treatment for pulmonary metastases was available for 38 patients: most patients (71%) received a gemcitabine-based chemotherapy regimen, 5 patients (13%) received best supportive care. After a median follow-up of 37.3 months, median survival after diagnosis of pulmonary metastasis was estimated with 25.5 months (95% CI 19.1–31.8); a significantly improved survival after diagnosis of pulmonary metastasis was observed for patients with less than 10 lung metastases (31.3 vs 18.7 months, p = 0.003) and for an unilateral localization of lung involvement (31.3 vs 21.8 months, p = 0.03). ConclusionsOur results suggest a favorable outcome of PC patients with isolated pulmonary metastases. Further research is warranted to elucidate the specific molecular characteristics of this rare subgroup.

Multidisciplinary management of pancreatic adenocarcinoma with isolated pulmonary metastases.

384 Background: Metastatic pancreatic adenocarcinoma (PAC) with isolated pulmonary metastases has recently been associated with prolonged overall survival. The purpose of this study was to review multi-disciplinary management and outcomes of these patients. Methods: Patients with PAC with pulmonary-only metastases were queried between 2012 to 2015 from a prospective single-institutional database. Results: Ten patients (median age: 71 yrs) were identified. Median number of lung metastases at diagnosis was 3 (range: 1 to innumerable). Seven patients had biopsy-proven lung metastases. Five presented with synchronous metastatic disease and five developed metachronous lung metastases as their first site of progression. Median time to progression between diagnosis of primary cancer to diagnosis of pulmonary metastases was 15 months (range: 4 to 31). Seven patients are alive as of this analysis. Median overall survival (OS) of this series (including two patients diagnosed 3 and 6 months ago) is 17 months, with longest overall survival = 40+ months (patient is still alive). All patients received gemcitabine-based chemotherapy; however, systemic regimens differed and included investigational agents. 3 of 5 patients with metachronous metastases underwent pancreaticoduodenectomy and are long-term survivors (34-40+ months). 2 of these 3 patients had diagnostic VATS of lung metastases and are alive with overall survival of 36+ months (resection of 2/3 nodules) and 34+ months (resection of all visible disease). Two patients with metachronous disease underwent neoadjuvant chemotherapy and pancreatic SBRT with progression to lung prior to planned surgery (OS: 30 months (deceased) and 6+ months (recently diagnosed)). 0 of 5 patients with synchronous metastatic disease had surgical resection; 3 of 5 received pancreatic SBRT. 3 of 10 patients are deceased due to visceral disease (14 months), pulmonary failure (18 months), and unknown causes (30 months). Conclusions: We report a recent single-institutional series of PAC with isolated lung metastases. Our data support that metastatic PAC patients with isolated pulmonary metastases have prolonged overall survival and suggest that local intervention may be beneficial.

Solitary pulmonary metastasis from occult papillary thyroid carcinoma.

Pulmonary metastases from thyroid carcinoma typically cause a micronodular or miliary pattern throughout both lungs. Metastasis consisting of a solitary pulmonary nodule measuring 20 mm in diameter is rare. Here we report a case of a 66-year-old woman without a history of papillary thyroid carcinoma who presented with a pulmonary nodule measuring 20 mm in diameter, found on chest computed tomography during a health checkup. The patient underwent a right lobectomy. Microscopic examination showed well-differentiated papillary adenocarcinoma. Immunohistochemical findings were consistent with a diagnosis of pulmonary metastasis from papillary thyroid carcinoma. Solitary metastasis to the lung from occult thyroid carcinoma is quite rare, but if a pulmonary nodule is encountered in a patient without a history of thyroid carcinoma, the possibility must be considered.

Pleura and lung

Incidental pulmonary nodules in patients that are imaged for staging purposes or during follow-up may represent metastases, second primary tumours (lung cancer) or benign nodules. The probability of pulmonary metastases or primary lung cancer differs depending on the number, size, size distribution and morphology of the nodules as well as the histologic type, stage, grade and other features of the known malignancy. A large proportion of pulmonary nodules in patients with known cancer are benign. Thus, an unconfounded diagnosis of pulmonary metastases has to be avoided in order not to falsely preclude potentially curative therapy of the primary tumour. Synchronous or metachronous second primary lung cancers in a patient with a known lung cancer have to be differentiated from pulmonary satellite nodules representing either advanced tumour stages or metastatic disease as they may be amenable to curative surgery. Pulmonary consolidation or ground glass attenuation most often represents infection and other non-malignant pathology but may occasionally be due to malignant lesions. Pleural effusions and focal or diffuse pleural thickening from benign causes need to be differentiated from lesions representing pleural carcinomatosis which represents metastastic disease. During this course examples of different incidental pulmonary and pleural lesions will be demonstrated and recommendations and guidelines for the management of the findings will be presented.

Lung Metastasis after an Eighteen-Years-Long Disease-Free Period since Uterine Leiomyosarcoma Diagnosis.

Uterine leiomyosarcoma (ULMS) is an uncommon malignancy that accounts for one-third of uterine sarcomas and represents 1% of all uterine malignancies, with an incidence averaging 0.5–1/100,000/year. The prognosis is poor due to its intrinsic aggressiveness and its characteristic high metastatic potential with reported distant metastatic spread in lung, abdomen, soft tissue, and brain. We present the case of a 67-year-old woman with lung metastasis after eighteen years since uterine leiomyosarcoma diagnosis and its following surgical resection. The diagnosis of pulmonary metastases was obtained by reviewing the histology of the previous uterine tumor: the tumor cells were immunoreactive for CD10, PR, and smooth muscle actin (SMA), but negative for desmin, S100, CD34, CD 117, cytokeratins AE1AE3, CD68R, and ER. To our knowledge, this disease-free interval is the longest among previous reports of pulmonary metastasis of uterine leiomyosarcoma.

Second primary non-small-cell lung cancer: implications of the new adenocarcinoma classification in the challenging decision of the best surgical strategy

Zuin et al. [1] have recently reported an interesting retrospective analysis on a relative large series of second primary non-small-cell lung cancers (NSCLCs), comparing the long-term outcomes between patients treated with a lobectomy and those where a sub-lobar resection was performed, which prompted a series of reflections by us, discussed here. The best therapeutic strategy for synchronous/metachronous primary NSCLCs remains an open subject of discussion in the scientific community, particularly regarding the surgical approach. By commenting on the paper by Zuin et al. [1], we wish to contribute to this debate. The International Association for the Study of Lung Cancer (IASLC) has issued a revised adenocarcinoma classification [2] jointly with the American Thoracic Society (ATS) and the European Respiratory Society (ERS). Briefly, the confusing term ‘bronchioloalveolar carcinoma’ has been discontinued and the entire category of pulmonary adenocarcinomas has been reclassified into three different subgroups: adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinomas (IA). As remarked in detail by Van Schil et al. [3], this new classification has profound implications for thoracic surgeons in the management of ‘early-stage’ adenocarcinomas; indeed the ‘early-stages’ AIS and MIA should have 100% or near 100% disease-specific survival after sub-lobar resection and mediastinal sampling, respectively, where the oncological need to perform a lobar resection and mediastinal lymph nodal systematic resection is reserved for IAs only. By extreme simplification we may infer that such relevant new evidence deserves focal attention when planning the best surgical strategy in second primary NSCLCs. First, we would like to encourage the authors to abandon the ‘old’ histopathological classification when matching data with the most updated TNM framework (7th). In particular, it would be extremely helpful to reclassify the vast amount of precious data according to the new classification to get significant clues (albeit with the limitations of a retrospective analysis exercise) for further prospective evaluations. Secondly and more generally, when an ‘early-stage’ adenocarcinoma is detected and rightfully classified as a synchronous or metachronous primary lung tumour, the decision-making process and the best strategy of treatment should mandatorily take into the account the new IASLC/ATS/ERS classification. Indeed, the same profound implications in the management of ‘early-stage’ adenocarcinomas (summarized above) may have a crucial value (or even more) in the management of ‘early-stage’ second adenocarcinomas too. Basically, the different surgical outcomes between lobar vs sub-lobar resections in a ‘second adenocarcinoma’ may be potentially influenced by the different prognostic pattern at the base of the new categories (AIS, MIA and IA). Thirdly and finally, as correctly remarked by the authors, ‘. . . the possibility that some cases of solitary pulmonary metastasis always exist within the group of patients with synchronous and early metachronous lung cancers could be included.’. In this context, although the IASLC/ATS/ERS classification recommended testing only patients with advanced adenocarcinomas for epidermal growth factor receptor (EGFR) mutations, we strongly advocate the assessment of EGFR mutations also in patients with synchronous/ metachronous primary adenocarcinomas, also, because the eventual differences in clonality may indeed be a helpful tool for the differential diagnosis of pulmonary metastases vs secondary lung neoplasms [4]. We would greatly appreciate the authors reflections and reactions to the points raised.

Preoperative Imaging of Pulmonary Metastases in Patients With Melanoma

Preoperative imaging underestimates the number of pulmonary melanoma metastases. Although thoracoscopic resection is less invasive than resection via thoracotomy, it does not allow manual palpation of the lung to identify any metastases not visible on the preoperative scan or at the time of resection. Retrospective review of a prospectively maintained database. Tertiary referral center. A total of 170 patients who underwent preoperative computed tomography of the chest, followed within 30 days by thoracotomy for resection of pulmonary metastatic melanoma. Number of pathology-confirmed pulmonary metastases detected by preoperative chest computed tomography vs intraoperative manual palpation. The mean age of the patients was 49.5 years at initial diagnosis of melanoma and 57.1 years at diagnosis of pulmonary metastases; 69% of patients were male. A total of 334 pulmonary metastases were resected; the mean lesion size was 2.0 cm (range, 0.1-14.0 cm). In 49 of 190 pulmonary resections (26%), manual palpation of the subpleural parenchyma revealed lesions not identified during preoperative imaging. The rate of 5-year overall survival was 33%. Preoperative imaging underestimates the number of pulmonary lesions in patients with metastatic melanoma. Because incomplete resection of metastatic disease is associated with worse outcomes, we recommend caution when considering a minimally invasive approach for the resection of pulmonary metastatic melanoma.

Lung metastases in metastatic gastric cancer: pattern of lung metastases and clinical outcome

There are only limited data regarding pulmonary metastasis from gastric cancer. Therefore, we analyzed large series of gastric cancer with pulmonary metastasis and analyzed their clinical characteristics and treatment outcome to enhance perception of metastatic gastric cancer. Of 20,187 advanced gastric cancer patients treated between 1995 and 2007, 193 (0.96%) were identified to have pulmonary metastasis from gastric cancer. The pulmonary lesions were detected at chest computed tomography (CT) scan or plain chest X-ray and/or abdominal pelvic CT scan covering the lower part of the lungs, and were divided into three patterns: lymphangitic, hematogenous, and pleural. The most frequently observed pattern of lung metastasis was hematogenous metastasis (52.3%) followed by pleural (35.2%) and lymphangitic (26.4%). Patients who had hematogenous pulmonary metastasis were significantly associated with hepatic metastasis (p = 0.004) and male sex (p = 0.012). Patients with lymphangitic metastasis were significantly associated with concomitant bone (p = 0.010) and bone marrow (p = 0.029) metastasis. In case of pleural metastasis, it was positively correlated with gastrectomy history (p = 0.015) and the presence of peritoneal metastasis (p = 0.020). After a median follow-up duration of 87 (9-162) months, the median survival after diagnosis of pulmonary metastasis was 4 (0-67) months. The most frequently observed pattern of lung metastasis was hematogenous metastasis (52.3%) followed by pleural (35.2%) and lymphangitic (26.4%) in gastric cancer patients. Among gastric cancer patients with lung metastases, patients with pleural metastasis or lymphangitic metastasis had shorter survival with 1.5-2-fold increased risk of deaths.

Pulmonary metastasis in patients with gestational trophoblastic disease

The medical records of 82 women who were admitted to the Institute of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia, between January 1, 2000, and October 31, 2007, for the treatment of gestational trophoblastic disease (GTD) were reviewed. The diagnosis of metastasis was based on clinical and radiologic evidence (chest X-ray and computed tomography) and on whether the women had elevated levels of serum human chorionic gonadotropin. Particular attention was paid to previous abortions, the interval between previous abortions and the diagnosis of metastasis, the mortality rate, and the need for hysterectomy. Ethics approval was not required for the present study. Of the 82 women, 9 (10.9%) had metastasis: 6 (7.3%) had pulmonary metastasis and 3 (3.6%) had vaginal metastasis. The present study focused on the 6 patients with pulmonary metastasis, 5 of whom were multiparous and had experienced a molar pregnancy within 1 year of the abortion of a preceding pregnancy. The ages of the women ranged from 25 to 51 years (mean, 36 years). A 39-year-old woman had primary GTD with pulmonary metastasis. The diagnosis of pulmonary metastasis was made using chest X-ray and, when the radiologic findings were deemed inconclusive, confirmed using computed tomography. All 6 women with pulmonary disease displayed non-specific signs of chest metastasis (periodic cough, dyspnea, and pleuritic pain), which they had ignored.

Thoracoscopic Resection of Solitary Pulmonary Nodules in Patients with Previous Malignant Tumors

Round opacities in the lungs found in the course of a neoplastic disorder or during the initial tumor staging are most often regarded as metastases without histological studies to prove their nature. These presumed metastases are, however, very often diagnosed later as benign lesions or primary malignant pulmonary tumors. To investigate the histological substrate of solitary pulmonary nodules in patients with a history of neoplastic condition and study the role of video-assisted thoracoscopy in their diagnosing and treatment. The study included 22 patients with solitary pulmonary nodules and history of previous malignant tumors who underwent video-assisted thoracoscopic surgery at the Clinic of Vascular and Thoracic Surgery, University Hospital Aschersleben, Germany between 01.01.2006 and 31.12.2009. Pulmonary wedge resection was performed and it was followed by histological verification. A diagnosis of pulmonary metastasis was confirmed in only 8 of the patients (36.4%). In another 8 of them (36.4%) the solitary pulmonary nodule proved to be a primary lung cancer, i.e. a second malignant tumor. The bronchial carcinoma was synchronous with the primary tumor in four of these patients, and metachronous in the rest. In the other 6 patients (27.2%) the lesions proved to be benign. Not all solitary pulmonary nodules in patients with preceding malignant formations are metastases. In order to define their nature more precisely they should be resected by video-assisted thoracoscopy, if possible. In benign lesions video-assisted thoracoscopic resection is the definitive medical procedure too.

Diagnosis of Pulmonary Metastases with Helical CT: The Effect of Imaging Techniques

Survival in patients after surgical resection of pulmonary metastases correlates with the complete resection of all metastatic deposits. The purpose of this study was to evaluate the additional value of helical CT to see whether the slice thickness and the reading environment was a factor determining the accuracy of helical scans. Between 2004 and 2007, 93 patients (62 men, 31 women) underwent complete resection of pulmonary metastases by open thoracotomy. A total of 125 thoracotomies were performed with manual palpation of the involved lung. We retrospectively examined the helical CT findings obtained using a 5-mm slice thickness in a routine preoperative analysis, and within this study a second reading was performed independently, using 3-mm slice thickness image sets. The CT images were evaluated in a consensus between two radiologists. Computed tomography scanning was performed a median of 12 days before thoracotomy (range 1-121 days). Analysis of helical CT in 5-mm slice thickness detected metastases with a sensitivity of 83.7 % whereas a 3-mm slice thickness had a sensitivity of 88.8 %. There were statistically significantly more lesions using helical CT and a 3-mm slice thickness technique than with the 5-mm slice thickness technique, compared to the surgical results ( P = 0.002). This was also found with regard to nodules which were finally histologically confirmed as lung metastases ( P = 0.014). We conclude that a reduced slice thickness may have an important positive impact on the treatment and outcome of patients with pulmonary metastases. The use of 3-mm slice thickness helical CT may raise the sensitivity for pulmonary metastases detection compared to 5-mm images, but the rate of false positive results may also increase.

The Role of Preoperative Chest CT in the Evaluation of a Colorectal Adenocarcinoma

Purpose: The most common metastatic site of colorectal adenocarcinomas is the liver, and the next common site is the lung. Pulmonary metastasis has been reported to be more common in rectal cancer (esp. lower rectum) than in colon cancer, and for pulmonary survival metastasis, a hepatic metastatectomy results in longer. Likewise, for hepatic metastasis, a pulmonary metastatectomy may prolong survival, and many reports of longer survival after a pulmonary metastatectomy have been published. We compared chest CT to chest PA as a preoperative diagnostic tool for the detection of pulmonary metastasis. Methods: The retrospective analysis was done for 369 consecutive patients with preoperative chest CT and chest PA who had a histologically-proven adenocarcinoma. Results: The detection rates of pulmonary metastases by preoperative chest PA and preoperative chest CT were 3.5% (13/369) and 8.4% (31/369), respectively. Pulmonary metastases were confirmed by surgical pathology and follow up for over 6 months to have occurred in 22 patients. Chest PA’s sensitivity and specificity for metastasis of colorectal cancer were 45% and 99%, respectively, and the positive predictive value was 76.9%. Chest CT had a sensitivity of 86%, a specificity of 96%, and a predictive positive value of 61.2% for pulmonary metastasis. Conclusions: Chest CT was more sensitive than chest PA in identifying pulmonary metastasis. Also, the detection rate for pulmonary metastasis by using chest CT was higher than that by using chest PA. Chest CT may be more useful in the diagnosis of pulmonary metastasis than chest PA as a preoperative work-up tool. The preoperative chest CT may help surgeons make decisions in the treatment for patients with a colorectal adenocarcinoma.

VAGINAL CLEAR CELL ADENOCARCINOMA WITH EARLY PULMONARY METASTASIS IN A CHILD

Although a few cases of vaginal clear cell adenocarcinoma (CCAC) have been reported in the ages under 14, they have presented in a much more aggressive form than the CCAC cases in higher ages and parenchymal pulmonary metastasis are known to occur following the primary tumor. This is a case report of a primary vaginal CCAC in an 8.6-year-old girl with no history of DES exposure who presented with vaginal bleeding and abdominal pain and the imaging signs of pulmonary metastasis at the presentation. Diagnostic imaging modalities should be considered for any child complaining of vaginal bleeding, due to limitation of vaginal examination. Chest X-ray is recommended at the time of diagnosis of CCAC and at follow-up sessions for early diagnosis of pulmonary metastasis.

Pulmonary metastasis of giant cell tumor of the bone diagnosed by fine‐needle aspiration biopsy

Giant cell tumor is a benign but locally aggressive tumor that primarily affects the epiphyses of long bones of young adults. Pulmonary metastases in giant cell tumor are rare (about 1-9%). Here, we report a case of metastatic pulmonary giant cell tumor in a patient who had a previous history of giant cell tumor of the distal femur with multiple recurrences. The diagnosis of pulmonary metastasis was achieved by cytologic evaluation with concurrent immunohistochemical studies in material obtained by fine-needle aspiration biopsy. The aspirate smears contained clustered and dispersed mononuclear and osteoclast-like giant cells that had bland nuclei with inconspicuous nucleoli. All multinucleated cells showed immunoreactivity to KP-1 antibody, a histiocytic marker (not lineage specific) and only a subset of mononuclear cells (30%) stained with this marker. Twenty percent of the mononuclear cells also displayed increased Ki-67 and p53 protein expression. The pulmonary metastasis was similar morphologically and immunophenotypically to the recurrent giant cell tumor of the bone.