We report a rare case of a lung adenocarcinoma presenting with chylothorax and metastases to the common bile duct and the rectum. From the radiological and endoscopic appearance of the tumors, the main differential diagnoses were metastatic lung cancer to multiple rare extra-thoracic sites and multiple synchronous primary oncological malignancies. Pathological examination of the biopsies with positive immunohistochemical staining for thyroid transcription factor-1 (TTF-1) played an important role in confirming metastatic pulmonary adenocarcinoma.

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Dear Editor,A 47-year-old Chinese woman was found to have mild transaminitis and a hepatic mass detected on ultrasound (US) at a routine medical check-up. She was subsequently referred to our institution for further investigations. She was asymptomatic and general physical examination was unremarkable. Hepatitis viral markers were negative and serum tumour markers, in particular alpha-fetoprotein (AFP), were normal. Magnetic resonance imaging (MRI), with primovist, revealed a slightly protuberant mass, measuring 3.4 cm in maximum dimension, arising from segment VII of the liver. It was hypointesnse on T1, isointense on T2 and demonstrated peripheral rim enhancement and minimal internal enhancement on the post-contrast phase. The radiologic features were suggestive of a fat-containing lesion with the differential diagnoses of hepatic adenoma, hepatocellular carcinoma (HCC) and angiomyolipoma. Given the concern for malignancy, a wedge resection was performed. At surgery, a well-defi ned subcapsular hepatic nodule was identifi ed. There was no involvement of the adjacent organs or peritoneal disease. The right adrenal gland was distinctly demarcated from the liver. The specimen was sent for intraoperative frozen section examination. The surgery was uneventful and the patient was well 3 months postoperatively.

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