Multiple Pulmonary Metastases Research Articles

Eyelid metastasis as first presentation of renal cell carcinoma

Abstract Case report An 87-year-old male presented with a slow-growing, painless and well defined nodule in the upper eyelid. The tumor measured 1 cm, and was pigmented and adhered to deep planes. The histopathology analysis was compatible with renal cell carcinoma. The extension study showed a tumor mass in each kidney, as well as multiple pulmonary metastases. Discussion The ophthalmologist can play an important role in the diagnosis of metastatic cancer when eye disease is present. Therefore, the importance of a biopsy should be noted in those suspicious and/or recurrent lesions of the eyelid.

Multiple pulmonary metastases with halo-sign from malignant mixed Müllerian tumors.

The lungs are one of the most common organs to which cancer metastasizes, but are a location not common for uterine sarcoma. A malignant mixed Müllerian tumor (MMMT) of the uterus is an extremely rare and aggressive sarcoma, characterized by a mixture of epithelial and mesenchymal components. There are few reports regarding the pulmonary metastasis from MMMTs. The present study presents the case of a 58-year-old woman with hemoptysis and post-menopausal vaginal bleeding. The woman was initially diagnosed with invasive aspergillosis based on a chest computed tomography (CT) scan showing multiple pulmonary nodular opacities surrounded by a ground-glass attenuation halo (halo-sign). Diagnostic curettage and a percutaneous CT-guided lung biopsy were conducted for the pathological diagnosis. Finally, the diagnosis was confirmed as MMMT with lung metastasis based on the histopathological examination of cervical canals, uterus and lung specimens, which showed a mixture of carcinomatous and sarcomatous elements, and morphology exhibiting hyperchromatic nuclei and necrosis. Immunohistochemical staining was positive for vimentin, focally positive for p16, and negative for napsin, cytokeratin 7 (CK7), CK20, carcinoembryonic antigen, carbohydrate antigen 125, homeobox protein CDX2 and villin in the lung specimens. This case highlights that pulmonary metastatic tumor from uterine sarcoma can present as halo-sign, which is commonly observed in pulmonary aspergillosis. Therefore, it needs to be considered in the differential diagnosis of such lesions, and pathological confirmation is required.

Near-fatal arterial air-embolism and pulmonary artery bleeding after repetitive radiofrequency ablation (RFA) and surgery for multiple pulmonary metastasis

Introduction A 49-year-old man, former top-athlete had whoops with residual tumour and re-resection of a pleomorphic rhabdomyosarcoma at the left thigh in 2008 followed by adjuvant radiotherapy. Since 2011 he developed a total of 24 lung metastases. He underwent resection via three right- and two left-sided thoracotomies, one RFA on the right and 8 RFA on the left side, as well as one left-sided stereotactic radiation. Additionally, a single hepatic metastasis was treated by RFA. Palliative chemotherapy (Myocet, Yondelis, Ixoten) proved futile. In spite of increasing technical challenge, another RFA of lung metastasis was scheduled. Case description For recurrent metastatic disease to the right lung RFA was applied, treating one central lesion and a second subpleural one, both in the upper lobe. The intervention was done in prone position under anaesthesia/intubation. Immediately after turning the patient to supine position he developed tachycardia followed by bradycardia and cardiac arrest. CPR was successful, but dramatic inflow-occlusion was evident. Immediate CT-control showed large amounts of air in the left heart, in the aorta, the coronary arteries and in the subarachnoidal vessels. While applying external pressure to both carotid arteries cardiac massage was continued in Trendelenburg's position, whereupon the inflow-occlusion lessened. Results and conclusions The patient was transferred to the hyperbaric chamber and had re-compression according to Navy 6 protocol starting one hour after the incident. After hyperbaric oxygen therapy (HBO) he opened his eyes and was able to move both legs. On the next day acute, severe hemorrhage from the endotracheal tube developed. CT-Angiography showed a 2cm bleeding pseudoaneurysm of a subsegmental artery at the site of the central RFA. Coil-embolization stopped the bleeding. Weaning problems necessitated tracheotomy. After further 9 HBO treatments neurology was almost normal. Following uneventful removal of the tracheal cannula the patient was discharged two weeks after RFA. Take-home message In the palliative setting local treatment of lung metastases can prolong life considerably. Yet multiple interventions may be a risk factor for adverse events. In highly compliant palliative patients with a good performance status severe complications of such measures can be handled.

The reasons why re-biopsies were not performed after failure with EGFR-TKI.

e20540 Background: Repeat biopsy becomes important to determine subsequent treatment after failure of EGFR-TKI. However, some patients did not receive re-biopsy in real world. Here we retrospectively analyzed the reasons why the patients did not receive re-biopsy. Methods: We reviewed medical records of 235 patients treated with EGFR-TKI at our institution between January 2014 and September 2016 and analyzed the treatment, the progression site after failure of EGFR-TKI and the reasons why they did not receive re-biopsy. Results: 127 of 235 (54%) patients had tumor progression after treatment with EGFR-TKI and 93 (73.2%) of 127 patients received re-biopsy and 34 (26.8%) patients didn’t. The characteristics of 34 patients who did not received re-biopsy were; the median age, 67 years (29-83), male/ female: 12/22, PS0-1/2 ≥:27/7, stage IV/recurrence/other:20/10/4, smoking history never/ex/current: 15/17/2, histology : adeno/other 34/0, EGFR mutation type; 19del/L858R/Other = 13/15/6, prior EGFR-TKI; Gefitinib/Erlotinib/Afatinib/other: 22/9/2/1. The commonest reason why they did not receive re-biopsy was no target lesion to get biopsy (n = 13,38%). CT scans of these patients were retrospectively evaluated and it was confirmed that there were no lesions that could be accessed safely at that time. Central nervous system lesions, multiple small pulmonary lesions and bone metastasis were unaccessible lesions. Although 21 patients had accessible lesions including lung, superficial lymph nodes, pleural effusion, liver, they did not receive re-biopsy because of patient refusal (n = 9), worsening of general condition (n = 3), need for other therapy immediately (ex: chemotherapy, radiotherapy) (n = 3), old age (n = 2), existence of de novo T790M (n = 2), complications (n = 1) and physician’s choice (n = 1). Conclusions: Some patients who did not recieve re-biopsy had some target lesions and it could be increase the re-biopsy rate.

A Case of Patient with Recurring Non-Small Cell Lung Carcinoma Treated with Samchilchoongcho-Jung in Conjunction with Afatinib

Objective The purpose of this study is to report the case of a patient with recurring non-small cell lung carcinoma (NSCLC) taking Samchilchoongcho-Jung with Afatinib. Methods An NSCLC patient diagnosed with multiple bone and pulmonary metastasis was taking Afatinib (20 mg/day) and suffering from stomatitis caused by the Afatinib. The patient was treated with Samchilchoongcho-Jung (1,500 mg/day) for 3 months. The tumor size was measured with computed tomography, and laboratory findings, including tumor markers (CEA, Cyfra 21-1), were also followed up. Stomatitis was measured by a numeric rating scale, and adverse events were evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 4.0. Results After combined treatment, stable disease was shown on computed tomography. The tumor marker levels of CEA and Cyfra 21-1 were decreased, and the stomatitis significantly improved. NCI-CTCAE 4.0 showed no adverse events. Conclusion This case study suggests that Samchilchoongcho-Jung may have a synergic effect, in conjunction with Afatinib, on the treatment of patients with recurring NSCLC. Keywords: non-small cell lung carcinoma, Afatinib, Samchilchoongcho-Jung, epidermal growth factor receptor

Reconstruction of bone defect with allograft and retrograde intramedullary nail for distal tibia osteosarcoma

BackgroundTo investigate the effectiveness of tibiotalocalcaneal arthrodesis with a retrograde nail and allograft in limb salvage surgery for patients with distal tibia osteosarcoma. Methods5 patients diagnosed as distal tibia osteosarcoma underwent ankle arthrodesis with a retrograde nail in our hospital. During the follow-up, radiographic views of the ankle joint were taken in two planes to assess bone healing and axis alignment. Other measurements of outcomes included procedure-related complications, local recurrence, and metastasis. Functional outcomes were evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. ResultsPostoperative complications occurred in 4 patients, including 4 cases of mild subcutaneous fluid and 1 case of screw breakage. All patients showed stable ankle and could stand or walk with the assistance of crutch before the complete union between allograft and host bone. One patient died due to multiple bone and pulmonary metastasis at 1 year after surgery. As for the other 4 patients, they were followed-up regularly for a mean period of 42 months. No local recurrence or distant metastasis occurred in any of these four patients. All the 4 patients expressed satisfaction with the outcome. According to MSTS scale, the mean postoperative functional score was 74.3%±4.4% (range, 70%–81%). ConclusionsIntramedullary retrograde nail for distal tibia osteosarcoma could produce a satisfactory outcome in terms of functional results and complications. Excellent stabilization of the ankle joint can be achieved through this technique, as it allows patients to perform much earlier postoperative weight-bearing exercise.

Metástasis palpebral como primera manifestación de un tumor renal

Case reportAn 87-year-old male presented with a slow-growing, painless and well defined nodule in the upper eyelid. The tumour measured 1cm, and was pigmented and adhered to deep planes. The histopathology analysis was compatible with renal cell carcinoma. The extension study showed a tumour mass in each kidney, as well as multiple pulmonary metastases. DiscussionThe ophthalmologist can play an important role in the diagnosis of metastatic cancer when eye disease is present. Therefore, the importance of a biopsy should be noted in those suspicious and/or recurrent lesions of the eyelid.

Computed tomography-guided implantation of 125 I seeds brachytherapy for recurrent multiple pulmonary oligometastases: initial experience and results

PurposeTo retrospectively evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous interstitial brachytherapy using 125I radioactive seeds for multiple pulmonary metastatic tumors.Material and methodsBetween September 2013 and December 2015, 22 patients with multiple pulmonary metastases, who after conventional chemotherapy and trans-arterial chemoembolization (TACE) therapy were considered unable to withstand stereotactic body radiation therapy (SBRT), received CT-guided 125I brachytherapy. Clinical data were studied retrospectively. A planning target volume of 90% (D90) was 120-160 Gy for 125I seeds with an activity of 25.9 MBq. A CT-based evaluation performed 1, 2, and 6 months’ post-implantation enabled review of local control of tumors.ResultsTwenty-two patients with 65 pulmonary metastases successfully completed treatment. The mean value for D90 for implantation for 125I seeds was 132 Gy. Complete response (CR) + partial response (PR) was documented in 81.54%, 78.46%, and 78.46% of patients at 1, 2, and 6 months after implantation, respectively. Fourteen out of 22 patients had CR, 3 had PR, 2 had stable disease (SD), and 3 had progressive disease (PD). Most of the metastases (CR + PR + SD; 87.69% after 6 months) were controlled by implantation.ConclusionsCT-guided 125I brachytherapy is a safe and effective treatment for multiple pulmonary metastatic tumors, and can achieve good short-term local control, so long as the radiation dose is sufficient.

A case report of denosumab treatment for multiple pulmonary metastasis of a giant cell tumor

A case report of denosumab treatment for multiple pulmonary metastasis of a giant cell tumor

Choriocarcinoma syndrome after resection of primary pulmonary choriocarcinoma: report of a case.

BackgroundChoriocarcinoma syndrome is known as a lethal complication from tumoral hemorrhage, which frequently occurs at the site of tumor metastasis.Case presentationA 59-year-old man with 60-pack-year smoking history was referred to our hospital because of hemoptysis. Chest computed tomography (CT) showed a 28 × 18 mm spiculated nodule with a cavity infiltrating the left upper lobe. A transbronchial lung biopsy was performed, and histopathological examinations revealed adenocarcinoma. No distant or regional metastasis was observed, and therefore, the patient underwent a left upper lobectomy with lymphadenectomy. Histological examinations showed that the tumor consisted of poorly differentiated adenocarcinoma cells and a choriocarcinomatous component; no multiple pulmonary metastases and mediastinal lymph node metastasis were observed. Immunohistochemical analysis showed a positive immunoreaction for human chorionic gonadotropin in the syncytiotrophoblastic cells of the choriocarcinoma. One month after the operation, the patient developed massive hemoptysis. CT showed diffuse alveolar infiltration in both the lungs. A bronchoscopic examination showed bleeding from the right upper bronchus. Aspiration cytology showed carcinoma. Despite blood transfusion and management in the intensive care unit, the patient died one and a half month after diagnosis.ConclusionsWe herein report a case of a man who developed choriocarcinoma syndrome 1 month after resection for combined choriocarcinoma and adenocarcinoma of the lung. Choriocarcinoma syndrome is a rare and life-threatening complication which may occur in patients with primary pulmonary choriocarcinoma. However, we need to consider the risk of this syndrome while dealing with patients who have massive hemoptysis.

Heterogeneity of Tumor Sizes in Multiple Pulmonary Metastases of Colorectal Cancer as a Prognostic Factor

The number of metastatic lesions is closely correlated with prognosis in most cancers. The aim of this study was to clarify the relationship between individual heterogeneity of metastatic tumor sizes and prognosis in patients with multiple pulmonary metastasis of colorectal cancer who received surgical treatment. Clinical data for patients who had pulmonary metastasis from colorectal cancer and underwent curative resection at 46 Japanese institutions between January 2004 and December 2008 were collected. Among 898 patients eligible considering these inclusion criteria, 247 patients had multiple metastases and were analyzed. A difference between the maximum and minimum tumor diameters (Dmax-min) on pathologic findings was used to evaluate size heterogeneity. The overall survival rate was 75% at 3 years and 58% at 5 years, with a median follow-up period of 65 months (range, 0 to 112). When Dmax-min of 5 mm was set as a cutoff value, overall survival was significantly different between small (≤5 mm, n= 95) and large (>5 mm, n= 152) tumor groups (5-year survival rates, 66.5% and 53.3%, respectively; log rank test, p= 0.025). Multivariate analysis using a Cox proportional hazards model revealed that disease-free interval from resection of primary lesion, serum carcinoembryonic antigen level, number of pulmonary metastases, and Dmax-min were independent prognostic factors. The heterogeneity of metastatic tumor sizes may be an indicator for prognosis in patients with multiple pulmonary metastases of colorectal cancer who underwent resection.

Pulmonary metastasectomy – A retrospective comparison of surgical outcomes after laser-assisted and conventional resection

IntroductionIndications and surgical techniques for pulmonary metastasectomy (PME) are controversially discussed issues. Laser-assisted surgery (LAS) is a recent innovation that has been advocated especially in patients with multiple pulmonary metastases (PM). However, there are hardly any studies comparing surgical outcomes after laser-assisted and conventional resection. The aim of the current study was to evaluate the value of LAS in a larger study population. Materials & methodsA retrospective analysis was completed on 178 consecutive patients undergoing 236 PMEs at a single center between 2010 and 2015. The main endpoint was survival. Statistical analysis was performed using the Kaplan–Meier method and survival rates were compared with the log rank test. Follow-up was done with special attention to the development of recurrent PM. Local relapse was defined as a recurrent metastasis in direct relation to the previously resected area according to CT scan comparisons. ResultsLAS was performed on 256 metastases in 99 patients, non-laser-assisted surgery (NLAS) on 127 metastases in 79 patients. 5-year-survival rates were 69.3% in all patients, 65.7% after LAS and 73.6% after NLAS. There was no statistically significant survival difference after LAS or NLAS (p = 0.41). The rate of local relapse was 0.8% after LAS vs 3.1% after NLAS (p = 0.073). ConclusionDespite a larger number of negative predictors for survival in LAS patients, overall survival (OS) was similar in the compared groups. There was also a trend for a lower risk of local relapses after LAS. Therefore, LAS should be considered a promising method for PME.

Improved antitumor activity and reduced myocardial toxicity of doxorubicin encapsulated in MPEG-PCL nanoparticles.

Doxorubicin (Dox) is a broad-spectrum antitumor drug used for the treatment of many types of malignant tumors. Although it possesses powerful antitumor activity, its clinical application is seriously encumbered by its unselective distribution and systemic toxicities, particularly myocardial toxicity. Thus, it is imperative to modify Dox to decrease its systemic toxicities and improve its therapeutic index. In the present study, we adopted a novel type of monomethoxy poly(ethylene glycol)-poly(ε-caprolactone) (MPEG-PCL) micelles to encapsulate Dox to prepare Dox-loaded MPEG-PCL (Dox/MPEG-PCL) nanoparticles by a controllable self-assembly process. The cellular uptake efficiency and cell proliferation inhibition of the Dox/MPEG-PCL nanoparticles were examined. The antitumor activity of the Dox/MPEG-PCL nanoparticles was tested on a multiple pulmonary metastasis model of melanoma on C57BL/6mice. Systemic toxicities and survival time were compared between the mice treated with the Dox/MPEG-PCL nanoparticles and free Dox. The potential myocardial toxicity of the Dox/MPEG-PCL nanoparticles was investigated using a prolonged observation period. Encapsulation of Dox in MPEG-PCL nanoparticles significantly improved the cellular uptake and cell proliferation inhibition of Dox invivo. Intravenous injection of Dox/MPEG-PCL nanoparticles obtained significant inhibition of the growth and metastasis of melanoma in the lung and prolonged survival time compared with free Dox (P<0.05). The Dox/MPEG-PCL nanoparticles did not show obvious additional systemic toxicities compared with free Dox during the treatment time. During the prolonged observation period, obvious decreased cardiac toxicity was observed in the Dox/MPEG-PCL nanoparticle-treated mice compared with that observed in the free Dox-treated mice. These results indicated that encapsulating Dox with MPEG-PCL micelles could significantly promote its antitumor activity and reduce its toxicity to the myocardium.

Abstract A11: An alveolar soft part sarcoma model to explore the mechanisms of tumorigenesis and metastasis

Abstract Alveolar soft part sarcoma (ASPS) is a highly malignant soft tissue tumor affecting predominantly children and adolescents in their buttocks or lower extremities. ASPS is characterized by its distinct histological features and t(X;17) translocation generating the ASPL-TFE3 gene fusion. However, the exact mechanisms of tumorigenesis and metastasis of ASPS remain largely unknown. A genetically engineered ASPS mouse model that showed histopothological and transriptome features similar to human ASPS has recently been established by M L Goodwin and L B Jones et al. (Cancer Cell 2014). An important role of lactate metabolism in the tumor microenvironment for sarcomagenesis was reported, though tumor localization was different from that of human ASPS. Using a different ex vivo approach, we have developed a model of ASPS. ASPL-TFE3 was retrovirally introduced into embryonic mesenchymal cells followed by allogenic transplantation. The histopathological examination of our ASPS model showed typical alveolar structures composed of tumor cells having round nuclei and abundant cytoplasms separated with delicate blood vessels. PAS-positive rod-shaped crystal structures, which are detected in human ASPS cells, were also observed in cytoplasm of the mouse ASPS cells. Electron micrograph showed that the mouse ASPS cells were rich in mitochondria and contains crystalline structures. Extensive and integral vasculogenesis followed by frequent hematogenous metastases are important biological properties of human ASPS. Our ASPS model also showed prominent angiogenesis and vascular involvement of tumor cells. Moreover, spontaneous multiple pulmonary metastases was frequently observed. However, tail vein injection of ASPS tumor cell suspensions failed to show pulmonary metastasis. Careful examination of tumor blood vessels as well as heart showed tumor emboli covered with non-neoplastic stromal cells. These cells were positive for α-smooth muscle actin and PDGFRβ and negative for CD31 and CD34, suggesting that they are originated from pericytes. In support of the idea, culture supernatants of mouse ASPS cells induced migration of the pericytes significantly. Collectively, these results suggest that cellular interaction between ASPS cells and pericytes plays an important role in hematogenous metastasis. Gene expression profiling of our mouse model and human ASPS identified genes involved in vaculogenesis including Angptl2, Ctsk, Mdk and Pdgfrd as upregulated genes. In addition, Gpnmb, a known target of TFE/MITF family transcription factors, was upregulated in mouse ASPS as well as embryonic mesenchymal cells introduced with ASPL-TFE3. Gpnmb encodes glycoprotein non-metastatic B that plays an important role in tumor invasion and cell-cell interaction. Immunostaining of Gpnmb showed its strong localization at the front of invasion and vascular involvement of ASPS tumor cells. Thus, metastatic processes of ASPS such as vasculogenesis, intra-vascular tumor invasion and protection of tumor cells in blood stream are orchestrated by the ASPL-TFE3 fusion protein in an appropriate cellular context. Citation Format: Miwa Tanaka, Yukari Yamazaki, Mizuki Homme, Takuro Nakamura. An alveolar soft part sarcoma model to explore the mechanisms of tumorigenesis and metastasis. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Pediatric Cancer Research: From Mechanisms and Models to Treatment and Survivorship; 2015 Nov 9-12; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(5 Suppl):Abstract nr A11.

再発と多発性肺転移を伴った皮膚の骨外性粘液性軟骨肉腫の犬の一例

再発と多発性肺転移を伴った皮膚の骨外性粘液性軟骨肉腫の犬の一例

Crizotinib Induced Rapid Remissions of Lung Adenocarcinoma

We present an imaging case of rapid pulmonary remission in a 50- year- old smoking woman. Our patient was a strong smoker (30 pack years), she has a pulmonary adenocarcinoma in right middle lobe with multiple pulmonary metastases. At first, she developed symptoms of strong coughing, for which she was referred in our center for further diagnosis and treatment. Histopathology from bronchoscopy of tumor filled middle lobe showed pulmonary adenocarcinoma (radiologic stage T4 N3 M1)

Cytogenetic Findings of an Undifferentiated Testicular Sarcoma

Primary testicular sarcomas are extremely rare. In contrast, germ cell tumors (GCTs) with sarcomatous components (SCs) that can have similar pathologic features are more frequently reported. We report a primary undifferentiated testicular sarcoma with cytogenetic analysis for amplification of 12p. A 36-year-old male initially presented with 9.4 cm right testicular tumor and no metastatic disease. He was lost to follow-up but re-presented 2 years later with tumor growth to 21 cm and multiple pulmonary and bone metastases. Histologically, the testicular tumor revealed an undifferentiated sarcoma. Fluorescence in situ hybridization (FISH) of paraffin-embedded tissue showed no amplification of 12p. Gain of isochromosome 12p (i(12p)) is a specific chromosomal anomaly present in most GCTs. The cytogenetic analysis indicated the possibility that the tumor was not of GCT origin. This is the first report of primary testicular undifferentiated sarcoma with cytogenetic analysis for i(12p). J Med Cases. 2016;7(1):7-12 doi: http://dx.doi.org/10.14740/jmc2356w

原発巣と転移巣がともに当初から薄壁空洞を呈した肺扁平上皮癌の1例

背景．肺癌では時に病巣の空洞化がみられるが，薄壁空洞を呈する症例は少ない．症例．55歳男性．X－3年6月に右上葉S2bの肺化膿症に罹患したが，この時既に右上葉S2aに14 mm大の嚢胞様病変が存在していた．その後，近医で経過観察中に右S2の病変が増大したため，X年11月当院へ再紹介された．胸部CTで右S2からS6にまたがる77 mm大の薄壁空洞病変を認め，尾側では空洞壁が肥厚していた．また両側肺野に大小様々の転移巣を認め，いずれも薄壁空洞を呈していた．肺扁平上皮癌と組織診断し，cisplatinとdocetaxelによる癌化学療法3サイクルを行った．原発巣と転移巣は，いずれもさらに薄壁化し嚢胞様を呈した．薄壁空洞を形成する機序として様々な仮説が報告されているが，本症例ではチェックバルブ機構の関与を疑った．結論．薄壁空洞性病変においても，肺癌の可能性も想定して注意深い経過観察が必要と考えられた．

Early tumor cavitation with regorafenib in metastatic colorectal cancer: A case report.

Tumoral cavity formation is a characteristic phenomenon reported in anti-angiogenic therapy in lung lesions. A 57-year-old male with multiple pulmonary metastases from colorectal cancer treated with an oral tyrosine kinase inhibitor, regorafenib, exhibited a characteristic cavity formation after the first two cycles. The decrease in the size of tumors was calculated as 38%, and there were associated decreases in the serum concentrations of the tumor markers carcinoembryonic antigen and CA19-9. After eight cycles of treatment, the cavity gradually disappeared through filling-in. This unique morphological response is not only reported in lung cancer but also in liver metastasis in colorectal cancer. However, the association between morphological changes including cavity formation and clinical benefit remains controversial. Pulmonary hemorrhage and pneumothorax are well-known consequences of cavitation, as reported with the other anti-angiogenic inhibitors. Early tumor cavitation in lung metastasis may demonstrate the predictive potential of regorafenib in colorectal cancer, although it is necessary to be mindful of toxicity.

Recurrent intracranial meningioma with multiple pulmonary metastases: A case report.

Meningiomas are slow-growing tumors, which are generally considered to be benign and rarely metastasize. Although cases of extracranial metastatic meningioma have previously been reported, multiple pulmonary metastases from a benign intracranial meningioma is particularly rare. In the present report, a case of recurrent transitional meningioma with multiple lung nodules, which were demonstrated to be metastatic meningioma, is presented. A 54-year-old female patient received surgical resection of the tumor located in the left base of the middle cranial fossa in 2006. Post-surgery pathological examination indicated a transitional meningioma of World Health Organization grade I. The tumor recurred at the original site 1 year and 3 months later and was completely surgically removed once again. Radiotherapy was administered following the second surgery. Gamma Knife was used to remove the recurrent tumor 18 months following the second surgery. Simultaneously, a chest computed tomography scan revealed multiple pulmonary nodules, which were demonstrated to be metastatic meningioma following wedge resection of the superior lobe of the right lung. The clinical behavior of meningioma does not always correlate with the classification of meningioma. A higher rate of cellular proliferation is not essential for extracranial metastasis, and an individual meningioma of any type may metastasize. Comprehensive examinations should be performed for patients with a history of recurrent intracranial meningioma to detect any distant metastases as early as possible, even when the primary tumor is benign.