대한흉부영상의학회 Weekly Chest Cases

Case No : 1048 Date 2017-11-27

Courtesy of Jin-Hwan Kim / Chungnam National University College of Medicine
Age/Sex 60 / F
Chief ComplaintGeneral weakness since 5 months ago

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Diagnosis With Brief Discussion

Diagnosis: Lung metastases from sarcoma
Radiologic Findings: Chest radiograph shows multiple variable-sized nodules and masses in both lungs. Contrast-enhanced CT scan of the chest shows multiple variable-sized hypervascular nodules and masses in the lungs. There are dilated, tortuous, and tubular enhancing structures within these lesions.
Mass in the right lower lobe was histologically confirmed as sarcoma of undifferentiated type, favoring metastatic sarcoma. On immunohistochemical study, vimentin and CD 10 were positive, while other markers, such as CK, p63, inhibin-alpha, alpha-SMA, CD31 and desmin, were negative. During work up for primary tumor, uterine mass of 6 cm was detected and suspected as sarcoma, but histologic diagnosis was not obtained since patient was discharged as hopeless.
Brief Review: Sometimes dilated, tortuous, and tubular enhancing structures within metastatic nodules are observed at contrast-enhanced CT. These structures are engorged tumor vessels that suggest the hypervascular nature of the metastatic nodules. Such findings are observed in cases of a metastasis from a sarcoma such as an alveolar soft-part sarcoma or a leiomyosarcoma.
References: Atypical Pulmonary Metastases: Spectrum of Radiologic Findings. Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Radiographics. 2001 Mar-Apr;21(2):403-17. Review.RadioGraphics 2001; 21:403–417
Keywords: Lung, Neoplasm_Malignant, Metastasis,

No. of Applicants : 85

▶ Correct Answer : 25/85, 29.4%

- Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- McGill University Health Center , Canada Alexandre Semionov
- NIMS, HYDERABAD , India BHASKAR K
- Ondokuz Mayis University , Turkey CETIN CELENK
- Other , Korea (South) HAYEON LEE
- Asan Medical Center , Korea (South) HYUN JUNG KOO
- Freelance resident in Reunion Island , Reunion Fabien HO
- Oita University, Faculty of Medicine , Japan Fumito Okada
- The Jikei university , Japan TAKU GOMI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Chonnam National University Hospital , Korea (South) JONG HYEON KIM
- VDC, HYDERABAD , India KARTHIK RAYASAM
- 怨紐 , Korea (South) jin young kim
- University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Other , Korea (South) SEONGSU KANG
- Azienda Ospedaliera di Cremona , Italy Pietro Sergio
- Sarawak General Hospital , Malaysia POHSEN TAY
- , Korea (South) DAE WOONG PARK
- District TB centre, kasaragod,India , India rikhy krishnan
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Kyemyung University Dongsan Hospital , Korea (South) DONG HYEON KIM

▶ Correct Answer as Differential Diagnosis : 9/85, 10.6%

- Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
- CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Korea university medical center, guro hospital , Korea (South) Lee kyu chong
- Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
- Seoul National University Hospital , Korea (South) YONGSUB SONG
- University of Utah , United States AKIHIKO SAKATA

▶ Semi-Correct Answer : 35/85, 41.2%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Niigata University , Japan ATSUSHI UEHARA
- Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- M P Shah Medical College Jamnagar Gujarat , India AKSHAY PARAMESHWAR PENDKAR
- King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
- IRSA LA ROCHELLE , France, Metropolitan BIGOT
- King abdulaziz specialized hospital taif , Egypt AHMED MHMOUD FAYED
- Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
- 罹stanbul , Turkey AYHAN YILMAZ
- university of montreal , Canada Andrei Bogdan Gorgos I
- Ajou University Hospital , Korea (South) Taeyang Ha
- Seoul National University Hospital , Korea (South) HYOUNG IN CHOI
- Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
- HHS , Canada S LEE
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Gifu University Hospital , Japan Yo Kaneko
- Kurashiki Central Hospital , Japan TORU KONISHI
- Samsung Medical Center , Korea (South) KYOWON GU
- Medicheck health care , Korea (South) Chae hun Lim
- tamilnadu , India MATHIYALAGAN M
- ALHAYAH SCAN RADIOLOGY CENTER , Egypt ELSAYED ELSAYED MOUSA
- Centre Hospitalier Regional de Lanaudiere , Canada Matthieu Storme
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
- The University of Tokyo Hospital , Japan TAKU TAJIMA
- , United Arab Emirates GAGAN WAHI
- MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
- , Iran SAEED TARIKI
- Teikyo University Hospital , Japan KAORU SUMIDA
- Private sector , Greece VASILIOS TZILAS
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- Pusan national university hospital , Korea (South) Jin Joo Kim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1048 Date 2017-11-27

Discussion

No. of Applicants : 85