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Weekly Chest CasesImaging Conference Cases

Case No : 6

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  • Age/Sex 40 / F
  • Case Title 40/F with dyspnea, wheezing (for several weeks)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Courtesy
K
Imaging Findings
CT shows large mass in right paratracheal area, lymph node enlargement.
The mass shows slightly heterogeneous attenuation and a small calcification is visible within it.
The mass extends to tracheal lumen, resulting in marked luminal narrowing.
On multiplanar and 3D images, the mass is located at lower trachea and extends into right main stem bronchus.
Despite the history of operation of ovarian cancer (serous papillary cystadenocarcinoma),
the initial CT diagnosis was primary malignant tumor of trachea with exophytic growth.
Discussion
Endobronchial metastasis from non-pulmonary tumors is uncommon.
The primary tumors included following types:
breast cancer (most common), colorectal cancer, melanoma, gastric cancer, neuroblastoma of the olfactory nerve,
abdominal leiomyosarcoma, hypernephroma, endometrial carcinoma, papillary thyroid cancer and hepatocelluar carcinoma.

Mediastinal or tracheal metastasis of ovarian tumor is a rare manifestation of recurrent ovarian cancer, but not rare as autopsy findings.

Patel at al. reported three case of supradiaphragmatic metastasis, in neck, mediastinal and axillary nodes
3 to 5 years after complete abdomino-pelvic remission.
Median interval from the diagnosis of the primary tumor to the diagnosis of endobronchial metastasis was 50.4 months.
Clinical presentations mimicked metastatic thyroid cancer, breast cancer and mesothelioma.
The most common clinical manifestations included cough, hemoptysis, dyspnea, and recurrent pulmonary infections.

Ovarian carcinomas usually spread by transcelomic, lymphatic or hematogenous dissemination to peritoneum,
pelvic and para-aortic lymph nodes, lung and pleura.
Women with papillary serous ovarian cancer may develop supradiaphragmatic disease
without evidence of peritoneal metastasis or primary pelvic tumors.
And supradiaphragmatic lymph nodes may heavily calcified.

Isolated supradiaphragmatic lymph nodes should not be assumed to be due to old granulomatous disease
as that may be the only clue to relapsing disease.

The prognosis of patients with endobronchial metastasis depends on the type of the primary tumor and the presence of other metastatic sites.
Malignant tracheal obstruction should be considered in the differential diagnosis of patients with advanced ovarian cancer and respiratory distress.
Reference
1. Montero CA, Gimferrer JM, Baldo X, Ramirez J. Mediastinal metastasis of ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol 2000;91:199-200
2. Patel SV, Spencer JA, Wilkinson N, Perren TJ. Supradiaphragmatic manifestations of papillary serous adenocarcinoma of the ovary. Clin Radiol 1999;54:748-754
3. Petru E. Friedrich G, Pickel H, Lax S, Beham A. Life-threatening tracheal metastasis complicating ovarian cancer-a case report. Gynecol Oncol 1999;74:141-142
4. Salud A, Porcel JM, Rovirosa A, Bellmunt J. Endobronchial metastatic disease: analysis of 32 cases. J Surg Oncol 1996;62:249-252
Keywords
Airway, Malignant tumor, metastasis,
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