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Weekly Chest CasesArchive of Old Cases

Case No : 848 Date 2014-01-27

  • Courtesy of Youkyung Lee, Jae Yeon Wi, Kwang Nam Jin / SMG-SNU Boramae Medical Center
  • Age/Sex 76 / M
  • Chief Complaintcough, blood tinged sputum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Endobronchial metastasis from renal cell carcinoma
Radiologic Findings
Chest PA and lateral shows partial atelectasis of the left upper lobe superior part with central mass. CT images shows well enhancing mass in the left upper lobe which has endobronchial component; we can also see distal mucus plugging and atelectasis. On FDG PET CT, the mass shows mild hypermetabolism (SUVmax 3.28); distal atelectasis and obstructive pneumonia has more avid FDG uptake.
Bronchoscopic image shows hypervascular polypoid mass in the left upper lobe bronchus.
The patient had a history of right nephrectomy due to renal cell carcinoma.
Brief Review
The common sources of endobronchial metastases are kidney, breast, and colorectal cancers. The common sources of endobronchial metastases are kidney, breast, and colorectal cancers.
In a study of 18 cases endobronchial metastases including three RCC, interval of primary RCC and endobronchial metastasis was 4, 7, and 19 years, respectively. For the other primary tumors (colorectal 4, breast 3, lymphoma 3, rhabdomyosarcoma 2, bladder 1, thyroid 1 and malignant melanoma 1), interval of endobronchial metastasis was synchronous or 1-8 years.
Pulmonary nodules are regarded as malignant if it had a wash in of >=25 HU. In a study of four patients of endobronchial metastasis from renal cell carcinoma (RCC), the endobronchial metastasis from the RCC showed very high attenuation (84-128 HU), and strong enhancement (51.6-93.3 HU) on the contrast-enhanced CT images.
References
1. Jeong, Y.J., et al., Solitary Pulmonary Nodule: Characterization with Combined Wash-in and Washout Features at Dynamic Multidetector CT. Radiology 2005;237:675-683
2. Park, C.M., et al., Endobronchial metastasis from renal cell carcinoma: CT findings in four patients. Eur J Radiol 2004;51(2): 155-9
3. Seo, J.B., et al., Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 2001; 21(2):403-17
4. Chang, J.M., et al., False Positive and False Negative FDG-PET Scans in Various Thoracic Diseases. Korean J Radiol, 2006;7(1):57-69
5. Park, J.W., M.K. Jo, and H.M. Lee, Significance of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for the postoperative surveillance of advanced renal cell carcinoma. BJU Int;2009;103(5):615-9
6. Dursun, A.B., et al., Endobronchial metastases: a clinicopathological analysis. Respirology 2005;10(4):510-514
Keywords
Airway, Malignant tumor,

No. of Applicants : 85

▶ Correct Answer as Differential Diagnosis : 21/85,  24.7%
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Research Hospital, The Institute of Medical Science, The University of Tokyo , Japan Toshihiro Furuta
  • - McGill university , Canada Badriya Al-Qassabi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - UWO , Canada S Lee
  • - National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - CAC Rennes , France nicolas gautier
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Private sector , Greece Vasilios Tzilas
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Medicheck health care , Korea (South) Chae Lim
  • - All India Institute of medical sciences , India Justin Moses
  • - kanto Rosai Hp , Japan Takana Yamakawa
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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