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Metastatic Lung Disease  

 

SOLITARY METASTASES

MULTIPLE  NODULES

 

  • Colon (30-40%)
  • Sarcomas, particularly from bone
  • Kidney
  • Testicle
  • Breast
  • Malignant melanoma

 

 

  • Kidney

·       Thyroid

  • Sarcoma of bone

LYMPHANGITIC SPREAD

CAVITARY METS

 

Lesions arise around chest

Simulate CHF

 

  • Lung
  • Breast
  • Thyroid
  • Larynx
  • Stomach
  • Pancreas
  • Cervix

 

 

Usually thick walled with nodular inner margin

 

  • Squamous cell primaries such as
  • Head and neck tumors
  • Ca of the cervix
  • Transitional cell ca
  • Melanoma
  • Adenocarcinoma

 

  • Mets to the lung occurs in about 30% of all malignant disease

  • Routes of spread include hematogenous, lymphangitic and direct extension

  • Lesions which spread by direct extension include carcinoma of the breast, liver or pancreas

  • Commonest pathway to the lungs is via systemic veins

  • Lymphangitic spread is actually first hematogenous; then, the cells invade lymphatics and travel antegrade back to the hila

  • Abscopal effect —metastatic lesion disappears spontaneously as the primary is removed– especially, kidney and trophoblastic malignancies

  • Cavitation occurs more often in the upper than the lower lung fields and most frequently in tumors of epithelial origin–such as squamous cell ca or    transitional cell ca

  • “Snowstorm” appearance of miliary mets–think of thyroid ca

  • Mets with long survivals– think of salivary gland tumors and alveolar cell ca

  • Mets with fuzzy borders —think of lesions that grow very quickly and bleed, such as metastatic choriocarcinoma

  • Mets that contain calcification—think of osteosarcoma, chondrosarcoma

  • Things that look like mets but aren’t—other causes of multiple nodules

    • AVMs

    • Wegener’s granulomatosis

    • Rheumatoid nodules

    • Septic emboli

    • Hamartomas

WH/’91  

 

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