Weekly Chest CasesArchive of Old Cases

Case No : 1096 Date 2018-10-29

  • Courtesy of Kyung Min Shin, MD. / Kyungpook National University, School of Medicine
  • Age/Sex 62 / M
  • Chief ComplaintIncidentally found chest radiograph abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Endobronchial and lung metastases from renal cell carcinoma
Radiologic Findings
Figs 1-2. Pre-contrast chest CT images show atelectasis with bronchial obstruction in the lateral segment of right middle lobe. A subpleural small nodule is also noted in the left lower lobe.
Fig 3-5. Contrast-enhanced CT images show well enhancement of endobronchial in the right middle lobe and lung nodules in the both lower lobes.
Fig 6. FDG PET/CT scan shows no avid FDG uptake in the whole body.
Brief Review
The common sources of endobronchial metastases are kidney, breast, and colorectal cancers. Renal cell carcinomas are hypervascular tumors and endobronchial metastases from renal cell carcinoma (RCC) show very high attenuation (84-128 H.U) and strong enhancement (51.6-93.3) on the contrast-enhanced CT images
Unlike for most other malignancies, application of FDG PET/CT is limited for RCC, mainly due to physiological excretion of FDG from the kidneys, which decreases contrast between renal lesions and normal tissue. RCC have inconsistent FDG uptake, which may be due to hypo- or isometabolism relative to background tissues and heterogeneity of glucose transporter expression (GLUT-1 gene). Generally, GLUT-1 gene is overexpressed at high grade clear cell RCC and it leads to high FDG uptake.
References
1. Liu Y., The Place of FDG PET/CT in Renal Cell Carcinoma: Value and Limitations. Front Oncol. 2016; 6;6:201.
2. Dursan, A.B.,et al., Endobronchial metastases: a clinicopathological analysis. Respirology 2005;10(4):510-514.
3. Park CM et al., Endobronchial metastases from renal cell carcinoma: CT findings in four patients. Eur J Radiol 2004;51(2):155-9.
Keywords
airway, lung, airway, malignant neoplasm , metastasis,

No. of Applicants : 76

▶ Correct Answer : 10/76,  13.2%
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
▶ Correct Answer as Differential Diagnosis : 11/76,  14.5%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
▶ Semi-Correct Answer : 4/76,  5.3%
  • - Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Fortis hospital , Mohali , India SHALEEN RANA
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