Solitary metastatic pulmonary nodule from breast cancer

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

Known left breast cancer (2014) post-surgery and chemoradiotherapy. Follow-up PET-CT showed a hypermetabolic left lung nodule.

Patient Data

Age: 75 years
Gender: Female

Suboptimal study due to motion artefacts.
Evidence of left mastectomy and left axillary clearance with no suspicious lesions seen in
the operative bed.
New well-defined pulmonary nodule in the lingula measuring 3.0 x 2.0 cm, pulmonary metastasis versus primary lung cancer; for further evaluation.
New left upper apical pulmonary fibrosis mostly related to the previous
radiotherapy.
No pleural or pericardial effusion. No sizable mediastinal, hilar or axillary lymph node.
A hiatus hernia is noted.
The liver is normal in size and attenuation with no hepatic focal lesions or dilated intrahepatic biliary radicles.
Unremarkable gallbladder, CBD, PV, pancreas, spleen, adrenals, kidneys
(apart from right cortical cysts and parenchymal tiny left kidney calcifications) urinary bladder, visualised opacified bowel loops and pelvic gynaecological organs (apart from
intrauterine mild retained fluid) No enlarged retroperitoneal or mesenteric lymph nodes.
Allowing for degenerative changes, the visualised bones are unremarkable.

CT

CT-guided percutaneous lung biopsy

The lesion was biopsied and sent for histopathology which revealed metastatic breast adenocarcinoma. 

CT

Follow up after 6 month of treatment

Comparison with previous CT scan.

Interval regression of the left upper lobe solitary pulmonary nodule measuring 1.6 x 1.2 cm, previously measuring 2.5 x 1.6 cm.

Stable left apical fibrotic changes. Right basal and left lingular subsegmental atelectasis is seen

No new suspicious pulmonary lesions are seen.   

No pleural or pericardial effusions seen.

No sizeable mediastinal, hilar, or axillary lymphadenopathy seen.

The visualised osseous structures show no suspicious bony lesion.

Unremarkable visualised upper abdomen.

Case Discussion

A 75-year-old woman with left breast cancer (2014), status post left modified radical mastectomy and chemoradiotherapy under follow-up. PET-CT showed a hypermetabolic pulmonary nodule with 13.8 SUV in the left lung, then referred to our department.

A solitary pulmonary nodule in the left lung without evidence of adenopathy. The nodule exhibited pleural indentation along the adjacent fissure. The lesion was suspected to be either primary lung cancer or pulmonary metastasis. A percutaneous lung biopsy showed that the nodule was metastatic (from breast cancer), the patient received systemic chemotherapy and is currently alive with good response and under follow up.

On CT, 46% of the solitary pulmonary nodules detected in patients with extrapulmonary malignancies were proved to be a metastasis at histopathological examination.

PlayAdd to Share

Case information

rID: 56585
Case created: 10th Nov 2017
Last edited: 14th Nov 2017
System: Chest
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.