Pulmonary metastases: can accurate radiological evaluation avoid thoracotomic approach?

Margaritora, Stefano; Porziella, Venanzio; D’Andrilli, Antonio; Cesario, Alfredo; Galetta, Domenico; Macis, Giuseppe; Granone, Pierluigi

doi:10.1016/s1010-7940(02)00119-7

Cited by 93 publications

(57 citation statements)

References 18 publications

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“…CT scans of metastatic lung cancer frequently reveal single or multiple spherical nodules with a smooth periphery (5). In the present case, CT revealed the characteristic halo sign, a solid nodule surrounded by a ground-glass attenuation halo.…”

Section: Discussionsupporting

confidence: 44%

“…Metastasis to the lungs is usually found through routine examinations, including lung CT and whole body PET. Patients with metastatic lung cancer present with primary tumor-related complications as the main clinical symptom and have no clear lung-related symptoms at an early stage (5). In the present case, hemoptysis that was reported as the only early clinical symptoms, and followed by vaginal bleeding are rare.…”

Section: Discussionmentioning

confidence: 53%

“…Secondly, the low pressure system and slow blood flow velocities of the pulmonary circulation are apt to allow tumor cells to stagnate (3,4). Metastatic neoplasm often present as multiple lung nodules and masses when incidental can be detected by a diagnostic chest radiography of computed tomography (CT) scan (5). Metastatic lung cancer frequently has non-specific symptoms and CT scans reveal single or multiple spherical nodules with a smooth periphery (5).…”

Section: Introductionmentioning

confidence: 99%

“…Metastatic neoplasm often present as multiple lung nodules and masses when incidental can be detected by a diagnostic chest radiography of computed tomography (CT) scan (5). Metastatic lung cancer frequently has non-specific symptoms and CT scans reveal single or multiple spherical nodules with a smooth periphery (5). However, metastatic lung cancer presenting with sustained hemoptysis as the initial symptom, with multiple nodular opacities surrounded by a ground-glass attenuation halo (halo-sign), which are commonly observed in pulmonary aspergillosis (6), have not been reported before.…”

Section: Introductionmentioning

confidence: 99%

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Multiple pulmonary metastases with halo‑sign from malignant mixed M?llerian tumors

Tian

Yang

et al. 2017

Oncol Lett

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Abstract. 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.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Multiple pulmonary metastases with halo‑sign from malignant mixed M?llerian tumors

Tian

Yang

et al. 2017

Oncol Lett

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“…With the rise of the fast high-resolution CT (HRCT), it is now possible to detect pulmonary nodules as small as 3 mm, which however results in a loss of sensitivity. Both conventional CT and HRCT have a sensitivity of 100% regarding nodules of 10 mm or higher (5). When the nodule size is smaller than 6 mm, the sensitivity of conventional CT drops to 63% and HRCT between 48-69% (5,6).…”

Section: Radiographic Diagnosis and Preoperative Imagingmentioning

confidence: 99%

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

Hengst¹,

Hendriks²,

Schil³

2012

Toraks Cer Bult

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Currently, surgical resection remains the gold standard for resectable lung metastases. Prognostic factors are histology, complete resection, number of metastases and disease-free interval. However, there is a high rate of recurrent disease in the thorax, even if systemic chemotherapy is applied. Because the latter is limited in dose due to systemic toxicity, new treatment options are being developed to selectively deliver high-dose chemotherapy into the lung, reducing systemic toxicity. Isolated lung perfusion (ILuP), similar to isolated limb perfusion, is an experimental surgical technique to deliver highdose chemotherapy into the lung without systemic exposure. Biological response modifiers like tumour necrosis factor can also be administered. ILuP results in significantly higher concentration of chemotherapy in the target organ compared to systemic chemotherapy, together with a survival benefit in experimental models of pulmonary metastases. Several phase I studies have shown that ILuP is technically feasible with low morbidity and low impact on the patient's pulmonary function. However, the utility of this technique is limited because it is an invasive technique. Other techniques to selectively deliver high-dose locoregional chemotherapy are embolic trapping (chemo-embolization), selective pulmonary artery perfusion (SPAP) without control of the venous effluent and the minimally invasive lung suffusion technique. This review will discuss surgical resection of lung metastases and address several techniques developed to deliver high doses of chemotherapy into the lung, as well as the current progress in experimental and clinical studies.

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MRI of the thorax during whole‐body MRI: Evaluation of different MR sequences and comparison to thoracic multidetector computed tomography (MDCT)

Frericks

Meyer

Martus

et al. 2008

Magnetic Resonance Imaging

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Purpose:To evaluate the accuracy of four MR sequences used as part of a whole-body MRI protocol to detect pulmonary lesions in cancer patients. Materials and Methods:A total of 31 oncology patients were imaged in a 1.5T MR scanner (Magnetom Avanto; Siemens Medical Solutions, Germany) for whole-body staging. MR chest imaging included: axial and coronal T2-weighted (T2w)-short-tau inversion-recovery (STIR), axial T2w turbo spin-echo (TSE), and contrast-enhanced (CE) three-dimensional (3D) volumetric interpolated breathhold examination (VIBE). Multidetector computed tomography (MDCT) of the thorax served as the reference standard. The MDCT and MR images were evaluated independently by two radiologists. Comparative analysis was performed per lesion, per lobe, and per patient. Sensitivity, specificity, and predictive values were determined.Results: Compared to MDCT that detected 268 pulmonary lesions ranging from 2 to 75 mm in diameter, the MR sensitivities were 91.1%, 92.5%, 90.8%, and 87.3% for the coronal STIR, the axial STIR, the axial T2w-TSE, and the axial CE 3D-VIBE, respectively. Undetected pulmonary lesions were either calcified or smaller than 10 mm in the axial diameter. With coronal STIR, six false-positive findings were detected; with axial STIR, 14 were detected; with axial T2w-TSE, 10 were detected; and with 3D-VIBE, seven were detected. Conclusion:Pulmonary MRI is feasible as part of a wholebody MRI protocol. In our study, STIR images achieved high accuracy compared to chest MDCT for pulmonary lesions of 3 mm in size or larger. IN MALIGNANT DISEASES, therapeutic options as well as the patient prognosis strongly depend on the tumor stage. Following recent developments in MR hardware, such as faster MR gradients, moving table technology, and multielement coil designs, MRI of the entire body in a single session is being increasingly utilized as an attractive alternative to computed tomography (CT) for whole-body tumor staging without exposing the patients to radiation (1,2). Due to its high soft-tissue contrast, the diagnostic accuracy of MRI is recognized in the musculoskeletal system, the head, the neck, and the abdomen (2-5). In the thorax, MRI has been used to assess tumors invading the chest wall and for mediastinal and cardiac tumors (6,7). For pulmonary imaging, MR is still perceived as inferior to multidetector CT (MDCT). However, as pulmonary lesion detection is an integral part of whole-body cancer imaging studies, a limited diagnostic accuracy in pulmonary staging could severely hamper the value of whole-body MRI of cancer patients.Recent MRI studies reported encouraging results for the detection of pulmonary nodules larger than 5-8 mm in diameter using single fast breathhold (BH) MR sequences in a limited number of patients (4,5,8 -11). Schroeder et al (11), for example, compared the diagnostic performance of a combined set of axial and coronal half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences with MDCT in a series of 30 patients and found a sensitivity for the detection ...

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Pulmonary metastases: can accurate radiological evaluation avoid thoracotomic approach?

Abstract: The sensitivity of HCT exceeds that of HRCT. However, complete manual exploration by thoracotomy remains the procedure of choice for patients undergoing pulmonary metastasectomy, because of limitation in preoperative radiological assessment of lung lesions smaller than 6 mm.

Cited by 93 publications

References 18 publications

Multiple pulmonary metastases with halo‑sign from malignant mixed M?llerian tumors

Multiple pulmonary metastases with halo‑sign from malignant mixed M?llerian tumors

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

MRI of the thorax during whole‐body MRI: Evaluation of different MR sequences and comparison to thoracic multidetector computed tomography (MDCT)

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