대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Metastatic Adenocarcinoma from Stomach Cancer

Radiologic Findings

Initial chest radiograph shows poorly defined opacities in both lungs, predominantly upper and peripheral lung zones. Chest CT scan shows multifocal patchy consolidations and ground glass opacities in both lungs.

This patient was admitted for evaluation of abdominal pain and dyspepsia. And gastric adenomcarcinoma was approved.

Thoracoscopic lung biopsy was performed in LUL and LLL. A photomicrograph of specimen with H & E stain reveals metastatic adenocarcinoma.

Brief Review

Lung metastases typically have two radiologic patterns: one or multiple nodules; and lymphangitis. However, it is known from histopathologic studies that metastases from adenocarcinoma may spread into the lung along the intact alveolar walls (lepidic growth), in a fashion similar to bronchioloalveolar carcinoma (BAC) [1]. In this pattern of growth, tumor cells line or fill alveoli in a manner analogous to that of exudative pneumonia, so called air-space pattern.

In a radiologic study [2], the air-space pattern of metastasis was high (10%). However, in one autopsy histopathologic study, Rosenblatt et al. [1] reported a percentage of pulmonary metastases showing a lepidic pattern of growth as high as 66% in small bowel adenocarcinoma, 27% in pancreatic adenocarcinoma, and 15% in colonic carcinoma. The discrepancy between radiologic and histologic frequency of air-space metastases supports the findings of Fraser et al. [3] that occasionally the growth pattern of metasasis is lepidic, but it is rarely sufficiently extensive to simulate confluent bronchopneumonia grossly.

In one study [3], air-space metastasis is a polymorphic disease strictly resembling BAC on CT. Air-space nodules, pulmonary consolidation, the angiogram sign, and nodules with the halo sign have been described in BAC.

References

1. Rosenblatt MB, Lisa JR,Collier F. Primary and metastatic bronchioloalveolar carcinoma. Dis Chest 1967; 52: 142-52

2. Gaeta M., Volta S., Scribano E. et al. Air-space pattern in lung metastasis from adenocarcinoma of the GI tract. J Comput Assist Tomogr 1996; 20: 300-304

3. Fraser RG, Pare JAP, Pare PD et al. Secondary neoplasms. In: Diagnosis of disease of the chest. Philadelphia: Saunders, 1999:1381-1417

Keywords

Lung, Malignant tumor,