대한흉부영상의학회 Weekly Chest Cases

Case No : 204 Date 2001-09-24

Courtesy of In Sun Lee, M.D., Jin Seong Lee, M.D., Koun-Sik So / Asan Medical Center, Seoul, Korea
Age/Sex 26 / F
Chief ComplaintBloody sputum, History of D & C for uterine tumor two months ago

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Hemorrahgic Metastasis from Choriocarcinoma
Radiologic Findings: Chest radiograph shows multiple, ill-defined nodular opacities in both lungs. HRCT scan shows multiple, ill-defined nodules with halo of ground glass attenuation in the periphery zones of both lungs.
Diagnosis was made based on clinical history of choriocarcinoma and radiologic findings. Serum HCG level was as high as 59,100 IU/ml.
Brief Review: The incidence of pulmonary metastases varies with the primary tumor and the stage of the disease. In autopsy series the most common sources of metastases to the lungs include tumors of breast, colon, kidney, uterus, prostate, head, and neck. Tumors such as choriocarcinoma, osteosarcoma, Ewing’s sarcoma, testicular tumors, melanoma and thyroid carcinoma have a high incidence of pulmonary metastases, but because they are not as prevalent in the population, lung deposits from these tumors are encountered less frequently (1, 2).
Hematogenous metastases usually result in multiple, large, well-defined nodules and tend to involve mainly the lower lung zones and frequently have a peripheral distribution. On occasion, if the metastases have bled into the surrounding lung, they show ill-defined edges.
The reported incidence of pulmonary metastasis of choriocarcinoma has ranged from 5.1- 67% (3). The pattern of thoracic metastasis from choriocarcinoma is variable, including pulmonary nodules with surrounding hemorrhage, miliary nodules, nodule or masses with arteriovenous aneurysm formation, and pulmonary or pleural metastasis with spontaneous hemothorax (2-5).
References: 1. Armstrong P, Wilson AG, Dee P, Hansell DM. Imaging of diseases of the chest, 2nd ed. St. Louis: Mosby 1995:344-350.
2. Seo JB, Im J-G, Goo JM, Chung MJ, Kim M-Y. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 2001; 21: 403-417
2. Tomada Y, Kasek S, Namk M et al. Pulmonary metastases of choriocarcinoma. Gan No Rinsho 1983; 29:550-554.
3. Caron F, Novati JP, Longlois D, Mazet B, Vincent J. Metastatic pulmonary choriocarcinoma and pulmonary arteriovenous aneurysm. Res Mal Respir 1995; 12:105-106.
4. Hirakata K, Nakata H, Nakagawa J. CT of pulmonary metastases with pathologic correlation. Semin Ultrasoud CT MR 1995; 16:379-394.
Keywords: Lung, Malignant tumor,

No. of Applicants : 27

▶ Correct Answer : 23/27, 85.2%

- 嫄닿뎅
- 寃쎈⑥
- 怨
- 怨
- 怨
- 怨
-
-
- 媛紐吏
-
- 諛李쎌
- 遺理以
-
- 源
- 諛
- 源
-
- 以
- CHU Nancy-Brabois, France Denis Regent
- IMSL, metz, France Eric Gaconnet
- Matsuyama Red Cross Hospital,Matsuyama,Japan Shunya Sunami
- Ospedale di Fabriano, Italy Giancarlo Passarini
- Seoul National University Hospital Tae Jung Kim

▶ Semi-Correct Answer : 4/27, 14.8%

- 遺理湲곕났
-
- Dong-A University Hospital Ki-Nam Lee
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 204 Date 2001-09-24

Discussion

No. of Applicants : 27