Metastasizing lung cancer

Case contributed by Mohamed Mahmoud Elthokapy

Presentation

Smoker patient presented by cough, hemoptysis, weight loss, and chest pain, as well as anterior superior chest wall hot tender mass.

Patient Data

Age: 55 years
Gender: Male
ct

Limited non-enhanced study has revealed:

  • Right lower lung lobe as well as right hilar heterogenous soft tissue masses measuring about 6.4x4 cm as well as 4.5x3.9 cm respectively The masses seen extending to the right hilum and para-hilar region encasing right main stem bronchus and bronchus intermedium with irregular borders and heterogenous densities mostly neoplastic (bronchogenic carcinoma) the posterior extent of the lesion shows further infiltration to chest wall (T4).

  • Multiple bilateral small pulmonary nodules are scattered randomly the largest about 7.5 mm at the left upper lung lobe apical segment mostly metastatic  

  • Enlarged mediastinal and hilar lymphadenopathy, some of them appear cystic/ degenerated measuring about 3.5 cm at the right para-tracheal group, moreover right supraclavicular nodal mass is about 5.5x4 cm (N3)

  • Right mild pleural effusion with underlying basal passive atelectasis.

  • Multiple vertebral, ribs , scapular, and sternal variable-sized heterogenous infiltrative soft tissue masses likely metastatic deposits (M1), the sternal mass showing superadded inflammatory process with possible abscess formation over manubrium sterni.

  • Bilateral adrenal soft tissue masses measuring about 3.5 cm and 3.8 cm at right and left sides respectively likely metastatic.

  • Left hepatic lobe hypodense focal mass lesion likely metastatic.

  • Heterogenous bulky thyroid gland with nodulation.

Case Discussion

Findings are suggestive of multifocal neoplastic metastatic disease (metastatic bronchogenic carcinoma; T4 N3 M1c; end-stage IVb) according to AJCC staging system

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