Presentation
Cough.
Patient Data
Cardiomediastinal outline is unremarkable. A rounded mass lesion is present in the right lower lobe. A destructive lesion of the left fifth rib laterally with associated pleural mass is noted.
Scans through the chest demonstrate a lobulated mass measuring 5.2 cm x 3.4 cm x 3.9 cm within the right lower lobe highly suggestive of a primary malignancy.
A borderline sized subcarinal lymph node measures 12 mm short axis. No further mediastinal adenopathy. A lytic /destructive lesion with associated soft tissue mass and pathological fracture in the left 5th rib laterally is in keeping with a metastasis.
The remainder of the lungs are clear apart from minor dependent change. Both adrenal glands are mildly bulky.
Conclusion:
Right lower lobe 5.2 centimeter mass suspicious for a primary malignancy with rib metastasis.
Case Discussion
The patient went on to have a biopsy (of a brain metastasis - not shown)
Histology
MICROSCOPIC DESCRIPTION: The section shows fragments of densely hypercellular, moderately differentiated adenocarcinoma. This consists of moderately well-formed glandular structures lined by a stratified arrangement of pleomorphic cuboidal and columnar epithelial cells. Areas with a solid arrangement of tumor cells are also noted. Frequent mitotic figures are identified and there are foci of tumor necrosis.
Immunohistochemistry shows strong cytoplasmic staining in tumor cells for cytokeratins CK7 and BerEp4. No staining for TTF-1, carcinoembryonic antigen (CEA), CDX-2 or cytokerartins CK 5&6 and CK20 is seen in tumor cells. This profile favors an origin of tumor from lung.
DIAGNOSIS: Metastatic moderately differentiated adenocarcinoma from lung.
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