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Wen X, Xue L, Jiang X, Jiang J, Li M, Zhang L. Case report: A 17-year-old male with primary pulmonary osteosarcoma. Front Med (Lausanne) 2024; 11:1364937. [PMID: 38576713 PMCID: PMC10991813 DOI: 10.3389/fmed.2024.1364937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Primary pulmonary osteosarcoma is one of the extraskeletal osteosarcomas originating from the lung with an extremely low incidence and highly invasive potential. Here we report a case of primary pulmonary osteosarcoma treated in our hospital with a literature review. The patient, a 17-year-old male, had a cough and hemoptysis for 20 days. Computed tomography (CT) and positron emission tomography (PET)/CT were performed in our hospital. According to pathological examination after surgery, the tumor was diagnosed as a high-grade sarcoma with remarkable osteogenesis and necrosis. Based on radiological and histological examinations, a diagnosis of primary pulmonary osteosarcoma originating was considered. The patient underwent surgery and adjuvant chemotherapy. This patient has been under consecutive follow-up for nearly 8 years, showing no signs of recurrence or distant metastasis. Primary pulmonary osteosarcoma is a rare lung malignancy that shows rapid progression, nonspecific symptoms and inapparent signs at an early stage. The diagnosis of primary pulmonary osteosarcoma highly relies on imaging and histological examinations, among which chest CT is the predominant method to check this disease.
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Affiliation(s)
- Xin Wen
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyan Xue
- Department of Pathology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Jiang
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiuming Jiang
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Li
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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2
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Yi E, Sunaguchi N, Lee JH, Seo SJ, Lee S, Shimao D, Ando M. Synchrotron Radiation Refraction-Contrast Computed Tomography Based on X-ray Dark-Field Imaging Optics of Pulmonary Malignancy: Comparison with Pathologic Examination. Cancers (Basel) 2024; 16:806. [PMID: 38398196 PMCID: PMC10886596 DOI: 10.3390/cancers16040806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Refraction-contrast computed tomography based on X-ray dark-field imaging (XDFI) using synchrotron radiation (SR) has shown superior resolution compared to conventional absorption-based methods and is often comparable to pathologic examination under light microscopy. This study aimed to investigate the potential of the XDFI technique for clinical application in lung cancer diagnosis. Two types of lung specimens, primary and secondary malignancies, were investigated using an XDFI optic system at beamline BL14B of the High-Energy Accelerator Research Organization Photon Factory, Tsukuba, Japan. Three-dimensional reconstruction and segmentation were performed on each specimen. Refraction-contrast computed tomographic images were compared with those obtained from pathological examinations. Pulmonary microstructures including arterioles, venules, bronchioles, alveolar sacs, and interalveolar septa were identified in SR images. Malignant lesions could be distinguished from the borders of normal structures. The lepidic pattern was defined as the invasive component of the same primary lung adenocarcinoma. The SR images of secondary lung adenocarcinomas of colorectal origin were distinct from those of primary lung adenocarcinomas. Refraction-contrast images based on XDFI optics of lung tissues correlated well with those of pathological examinations under light microscopy. This imaging method may have the potential for use in lung cancer diagnosis without tissue damage. Considerable equipment modifications are crucial before implementing them from the lab to the hospital in the near future.
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Affiliation(s)
- Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea;
| | - Naoki Sunaguchi
- Department of Radiological and Medical Laboratory Sciences, Graduate School of Medicine, Nagoya University, Nagoya 461-8673, Japan;
| | - Jeong Hyeon Lee
- Department of Pathology, Korea University Anam Hospital, Seoul 02841, Republic of Korea;
| | - Seung-Jun Seo
- Department of Experimental Animal Facility, Daegu Catholic University Medical Center, Daegu 42472, Republic of Korea;
| | - Sungho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea;
| | - Daisuke Shimao
- Faculty of Health Sciences, Butsuryo College of Osaka, Osaka 593-8328, Japan;
| | - Masami Ando
- Photon Factory, Institute of Materials Structure Science, High-Energy Accelerator Research Organization, Tsukuba 300-3256, Japan;
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3
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Doerr F, Giese A, Höpker K, Menghesha H, Schlachtenberger G, Grapatsas K, Baldes N, Baldus CJ, Hagmeyer L, Fallouh H, Pinto dos Santos D, Bender EM, Quaas A, Heldwein M, Wahlers T, Hautzel H, Darwiche K, Taube C, Schuler M, Hekmat K, Bölükbas S. LIONS PREY: A New Logistic Scoring System for the Prediction of Malignant Pulmonary Nodules. Cancers (Basel) 2024; 16:729. [PMID: 38398120 PMCID: PMC10887049 DOI: 10.3390/cancers16040729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES Classifying radiologic pulmonary lesions as malignant is challenging. Scoring systems like the Mayo model lack precision in predicting the probability of malignancy. We developed the logistic scoring system 'LIONS PREY' (Lung lesION Score PREdicts malignancY), which is superior to existing models in its precision in determining the likelihood of malignancy. METHODS We evaluated all patients that were presented to our multidisciplinary team between January 2013 and December 2020. Availability of pathological results after resection or CT-/EBUS-guided sampling was mandatory for study inclusion. Two groups were formed: Group A (malignant nodule; n = 238) and Group B (benign nodule; n = 148). Initially, 22 potential score parameters were derived from the patients' medical histories. RESULTS After uni- and multivariate analysis, we identified the following eight parameters that were integrated into a scoring system: (1) age (Group A: 64.5 ± 10.2 years vs. Group B: 61.6 ± 13.8 years; multivariate p-value: 0.054); (2) nodule size (21.8 ± 7.5 mm vs. 18.3 ± 7.9 mm; p = 0.051); (3) spiculation (73.1% vs. 41.9%; p = 0.024); (4) solidity (84.9% vs. 62.8%; p = 0.004); (5) size dynamics (6.4 ± 7.7 mm/3 months vs. 0.2 ± 0.9 mm/3 months; p < 0.0001); (6) smoking history (92.0% vs. 43.9%; p < 0.0001); (7) pack years (35.1 ± 19.1 vs. 21.3 ± 18.8; p = 0.079); and (8) cancer history (34.9% vs. 24.3%; p = 0.052). Our model demonstrated superior precision to that of the Mayo score (p = 0.013) with an overall correct classification of 96.0%, a calibration (observed/expected-ratio) of 1.1, and a discrimination (ROC analysis) of AUC (95% CI) 0.94 (0.92-0.97). CONCLUSIONS Focusing on essential parameters, LIONS PREY can be easily and reproducibly applied based on computed tomography (CT) scans. Multidisciplinary team members could use it to facilitate decision making. Patients may find it easier to consent to surgery knowing the likelihood of pulmonary malignancy. The LIONS PREY app is available for free on Android and iOS devices.
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Affiliation(s)
- Fabian Doerr
- Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Annika Giese
- Department of Anesthesiology and Intensive Care Medicine, Vinzenz Pallotti Hospital Bergisch Gladbach-Bensberg, GFO-Clinics Rhein-Berg, 51429 Bergisch Gladbach, Germany
| | - Katja Höpker
- Clinic III for Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | - Hruy Menghesha
- Department of Thoracic Surgery, Helios Clinic Bonn/Rhein-Sieg, 53123 Bonn, Germany
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
| | - Georg Schlachtenberger
- Department of Cardiothoracic Surgery, University Hospital of Cologne, University of Cologne, 50923 Cologne, Germany
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Natalie Baldes
- Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Christian J. Baldus
- Institute for Diagnostic and Interventional Radiology, University Hospital Dresden, 01307 Dresden, Germany
| | - Lars Hagmeyer
- Clinic for Pneumology and Allergology, Bethanien Hospital GmbH Solingen, 42699 Solingen, Germany
| | - Hazem Fallouh
- Department of Cardiothoracic Surgery, University Hospital of Birmingham, Birmingham B15 2GW, UK
| | - Daniel Pinto dos Santos
- Department of Radiology, University Hospital Cologne, 50937 Cologne, Germany
- Department of Radiology, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Edward M. Bender
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA 94304, USA
| | - Alexander Quaas
- Institute of Pathology, University of Cologne, 50923 Cologne, Germany
| | - Matthias Heldwein
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
| | - Thorsten Wahlers
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany
| | - Kaid Darwiche
- Department of Pneumology, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Christian Taube
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Khosro Hekmat
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
| | - Servet Bölükbas
- Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
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Gil-García CA, Cueto-Robledo G, Gonzalez-Hermosillo LM, Alfaro-Cruz A, Roldan-Valadez E. Nonthrombotic Pulmonary Embolism Associated With Non-Hodgkin Lymphoma. Curr Probl Cardiol 2023; 48:102001. [PMID: 37506958 DOI: 10.1016/j.cpcardiol.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Nonthrombotic pulmonary embolism (NTPE) challenges the medical community with its diverse etiologies and potential life-threatening implications. The classification section delves into the multifaceted nature of NTPE, which includes various embolic agents that traverse the vascular system. From air and fat emboli to tumor and amniotic fluid emboli, this exploration of diverse etiologies sheds light on the complexity of NTPE. Diagnostic methods play a crucial role in the effective management of NTPE. This article describes a range of traditional and cutting-edge diagnostic techniques, from computed tomography angiography to novel biomarkers, enabling the accurate and timely identification of NTPE. NTPE treatment options are diverse and patient-specific, requiring customized approaches to address varying embolic sources. Anticoagulation, embolus removal, and emerging interventions under study are discussed, providing clinicians with a comprehensive understanding of management strategies. This article uncovers the rare but captivating association between NTPE and non-Hodgkin lymphoma. Although rare, documented cases have sparked curiosity among researchers and medical practitioners. We explore potential pathophysiological connections, discussing challenges and considerations when encountering this unique scenario. In conclusion, this captivating review encapsulates the multifaceted realm of NTPE, covering its classification, diagnostics, and treatment modalities. Moreover, it presents a fascinating connection with non-Hodgkin lymphoma. This article offers a comprehensive and concise review of NTPE, guiding readers through its intricate classification, diagnostic approaches, and therapeutic interventions.
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Affiliation(s)
- Cesar-Alejandro Gil-García
- Faculty of Medicine, Autonomous University of Sinaloa, Los Mochis, Sinaloa, México; Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Pulmonary Circulation Clinic, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | | | - Ana Alfaro-Cruz
- Department of Surgical Pathology, General Hospital of Mexico, "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico; Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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Fukuda T, Egashira R, Ueno M, Hashisako M, Sumikawa H, Tominaga J, Yamada D, Fukuoka J, Misumi S, Ojiri H, Hatabu H, Johkoh T. Stepwise diagnostic algorithm for high-attenuation pulmonary abnormalities on CT. Insights Imaging 2023; 14:177. [PMID: 37857741 PMCID: PMC10587054 DOI: 10.1186/s13244-023-01501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/12/2023] [Indexed: 10/21/2023] Open
Abstract
High-attenuation pulmonary abnormalities are commonly seen on CT. These findings are increasingly encountered with the growing number of CT examinations and the wide availability of thin-slice images. The abnormalities include benign lesions, such as infectious granulomatous diseases and metabolic diseases, and malignant tumors, such as lung cancers and metastatic tumors. Due to the wide spectrum of diseases, the proper diagnosis of high-attenuation abnormalities can be challenging. The assessment of these abnormal findings requires scrutiny, and the treatment is imperative. Our proposed stepwise diagnostic algorithm consists of five steps. Step 1: Establish the presence or absence of metallic artifacts. Step 2: Identify associated nodular or mass-like soft tissue components. Step 3: Establish the presence of solitary or multiple lesions if identified in Step 2. Step 4: Ascertain the predominant distribution in the upper or lower lungs if not identified in Step 2. Step 5: Identify the morphological pattern, such as linear, consolidation, nodular, or micronodular if not identified in Step 4. These five steps to diagnosing high-attenuation abnormalities subdivide the lesions into nine categories. This stepwise radiologic diagnostic approach could help to narrow the differential diagnosis for various pulmonary high-attenuation abnormalities and to achieve a precise diagnosis.Critical relevance statement Our proposed stepwise diagnostic algorithm for high-attenuation pulmonary abnormalities may help to recognize a variety of those high-attenuation findings, to determine whether the associated diseases require further investigation, and to guide appropriate patient management. Key points • To provide a stepwise diagnostic approach to high-attenuation pulmonary abnormalities.• To familiarize radiologists with the varying cause of high-attenuation pulmonary abnormalities.• To recognize which high-attenuation abnormalities require scrutiny and prompt treatment.
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Affiliation(s)
- Taiki Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga-City, Saga, 849-8501, Japan
| | - Midori Ueno
- Department of Radiology, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8556, Japan
| | - Mikiko Hashisako
- Department of Pathology, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka-City, Fukuoka, 812-8582, Japan
| | - Hiromitsu Sumikawa
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, 591-8555, Japan
| | - Junya Tominaga
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Daisuke Yamada
- Department of Radiology, St. Luke's International Hospital, 9-1, Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki-City, Nagasaki, 852-8523, Japan
| | - Shigeki Misumi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
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Yoshioka S, Takahashi N, Fujisaki M, Takeshita K, Takano Y, Yano F, Toya N, Eto K. Long-term survival after multidisciplinary treatments for HER2-positive advanced gastric cancer with multiple liver and lung metastases. Surg Case Rep 2023; 9:139. [PMID: 37548808 PMCID: PMC10406778 DOI: 10.1186/s40792-023-01714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Trastuzumab-based chemotherapy is a standard treatment regimen for human epithelial growth factor 2 (HER2)-positive gastric cancer. This is a case of a patient who has survived 12 years after being diagnosed with advanced gastric cancer with multiple liver and lung metastases. CASE PRESENTATION A woman in her 70s underwent total gastrectomy, cholecystectomy, and left hepatic lobectomy for gastric cancer with liver metastasis. One month after the surgery, multiple liver metastases appeared. After two courses of S-1 + CDDP chemotherapy, the liver metastases disappeared, and new lung metastases occurred. Because the primary tumor was HER2 positive, S-1 + CDDP + trastuzumab chemotherapy was performed. After one course of chemotherapy, the blood test showed pancytopenia, and CDDP was discontinued. S-1 + trastuzumab chemotherapy was then initiated, and as a result, the lung metastases disappeared. The patient is alive without recurrence 12 years after the surgery. CONCLUSIONS We encountered a case of long-term survival after multidisciplinary treatments for HER2-positive advanced gastric cancer with multiple liver and lung metastases.
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Affiliation(s)
- Satoshi Yoshioka
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Naoto Takahashi
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Muneharu Fujisaki
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8471 Japan
| | - Kenji Takeshita
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Yuta Takano
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Fumiaki Yano
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8471 Japan
| | - Naoki Toya
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8471 Japan
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7
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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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8
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Guo J, Liao Z, Dong A. FDG PET/CT in a Case of Lung Adenocarcinoma With Diffuse Cavitary Intrapulmonary Metastases. Clin Nucl Med 2023; 48:428-430. [PMID: 36728232 DOI: 10.1097/rlu.0000000000004534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT We describe FDG PET/CT findings in a case of lung adenocarcinoma with diffuse cavitary intrapulmonary metastases at initial diagnosis. High-resolution CT of the chest showed the primary solid tumor in the right upper lobe and numerous cavitating metastases ranging from a few millimeters to 1 cm in the bilateral lungs. FDG PET/CT showed intense activity of the primary tumor, diffuse activity of the lung metastases, and hypermetabolic metastases in the mediastinal lymph nodes and bones. Familiarity with this atypical intrapulmonary metastatic pattern of lung cancer may be helpful for the diagnosis and differential diagnosis.
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Affiliation(s)
- Jia Guo
- From the Departments of Nuclear Medicine
| | | | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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9
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Silva JAM, Marchiori E, Amorim VB, Barreto MM. CT features of osteosarcoma lung metastasis: a retrospective study of 127 patients. J Bras Pneumol 2023; 49:e20220433. [PMID: 37132704 PMCID: PMC10171270 DOI: 10.36416/1806-3756/e20220433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/26/2023] [Indexed: 03/31/2023] Open
Abstract
Objective: Osteosarcoma lung metastases have a wide variety of CT presentations, representing a challenge for radiologists. Knowledge of atypical CT patterns of lung metastasis is important to differentiate it from benign lung disease and synchronous lung cancer, as well as to determine the extent of primary disease. The objective of this study was to analyze CT features of osteosarcoma lung metastasis before and during chemotherapy. Methods: Two radiologists independently reviewed chest CT images of 127 patients with histopathologically confirmed osteosarcoma treated between May 10, 2012 and November 13, 2020. The images were divided into two groups for analysis: images obtained before chemotherapy and images obtained during chemotherapy (initial CT examination). Results: Seventy-five patients were diagnosed with synchronous or metachronous lung metastases. The most common CT findings were nodules (in 95% of the patients), distributed bilaterally (in 86%), with no predominance regarding craniocaudal distribution (in 71%). Calcification was observed in 47%. Less common findings included intravascular lesions (in 16%), cavitation (in 7%), and the halo sign (in 5%). The primary tumor size was significantly greater (i.e., > 10 cm) in patients with lung metastasis. Conclusions: On CT scans, osteosarcoma lung metastases typically appear as bilateral solid nodules. However, they can have atypical presentations, with calcification being the most common. Knowledge of the typical and atypical CT features of osteosarcoma lung metastasis could play a key role in improving image interpretation in these cases.
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Affiliation(s)
| | - Edson Marchiori
- . Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Viviane Brandão Amorim
- . Departamento de Radiologia, Instituto Nacional do Câncer, Rio de Janeiro (RJ) Brasil
- . Departamento de Radiologia, Grupo Fleury S.A., Rio de Janeiro (RJ) Brasil
| | - Miriam Menna Barreto
- . Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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10
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Dündar Çağlayan CN, Engin MN, Boz A. A Rare Case and Atypical Metastatic Regions, Pulmonary Giant Cell Carcinoma. Mol Imaging Radionucl Ther 2023; 32:74-76. [PMID: 36820010 PMCID: PMC9950673 DOI: 10.4274/mirt.galenos.2022.50133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Sixty two years old man referred to our clinic due to suspicion of thymic mass. The hypermetabolic nodular lesion in the right lung upper lobe was seen in 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in addition to the mass in the anterior mediastinum which was found to without malignancy. The patient underwent wedge resection and final diagnosis was pulmonary giant cell carcinoma. In follow-up 18F-FDG PET/CT multiple lesions with pathological activity were observed in the cerebrum, right postauricular region, bilateral adrenal, stomach, pancreas, pelvic soft tissue, mesenteric, left femur and bilateral lung parenchyma 6 months after. The pathology results of the right frontal, pelvic mass and the postauricular region were metastasis.
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Affiliation(s)
- Ceyda Nur Dündar Çağlayan
- Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey,* Address for Correspondence: Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey Phone: +90 242 227 64 85 E-mail:
| | - Müge Nur Engin
- Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey
| | - Adil Boz
- Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey
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11
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Gabelloni M, Faggioni L, Fusco R, Simonetti I, De Muzio F, Giacobbe G, Borgheresi A, Bruno F, Cozzi D, Grassi F, Scaglione M, Giovagnoni A, Barile A, Miele V, Gandolfo N, Granata V. Radiomics in Lung Metastases: A Systematic Review. J Pers Med 2023; 13:jpm13020225. [PMID: 36836460 PMCID: PMC9967749 DOI: 10.3390/jpm13020225] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
Due to the rich vascularization and lymphatic drainage of the pulmonary tissue, lung metastases (LM) are not uncommon in patients with cancer. Radiomics is an active research field aimed at the extraction of quantitative data from diagnostic images, which can serve as useful imaging biomarkers for a more effective, personalized patient care. Our purpose is to illustrate the current applications, strengths and weaknesses of radiomics for lesion characterization, treatment planning and prognostic assessment in patients with LM, based on a systematic review of the literature.
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Affiliation(s)
- Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Faggioni
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
- Correspondence: ; Tel.: +39-050-992524
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, “Antonio Cardarelli” Hospital, 80131 Naples, Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, 20122 Milan, Italy
| | - Diletta Cozzi
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Francesca Grassi
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Mariano Scaglione
- Department of Surgery, Medicine and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
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12
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Zarfati A, Martucci C, Crocoli A, Serra A, Persano G, Inserra A. Chemotherapy-induced cavitating Wilms' tumor pulmonary metastasis: Active disease or scarring? A case report and literature review. Front Pediatr 2023; 11:1083168. [PMID: 36925669 PMCID: PMC10011097 DOI: 10.3389/fped.2023.1083168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/01/2023] [Indexed: 03/18/2023] Open
Abstract
The second most common abdominal tumor in children is Wilms' tumor, and the lung is where it most often metastasizes. The typical metastases are multiple, peripherally located, round, and variable-sized nodules. Atypical patterns are also possible and may create diagnostic challenges, especially in patients treated with chemotherapy. Among these, cavitating metastases are an anecdotal type of atypical secondary lung lesions. Here, we report a case of a chemotherapy-induced cavitating Wilms' tumor pulmonary metastasis discovered during the follow-up for an anaplastic nephroblastoma in a 6-year-old girl. Furthermore, we conducted a review of the existing literature on this exceedingly rare radiological pattern to establish its best management.
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Affiliation(s)
- Angelo Zarfati
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy.,Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Cristina Martucci
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Annalisa Serra
- Hematology/Oncology Unit, Department of Pediatric Hematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Giorgio Persano
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Alessandro Inserra
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
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13
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Jackson JIF, Au-Yong ITH, Higashi Y, Silverman R, Clarke CGD. Pulmonary metastases from mucinous colorectal cancers and their appearance on CT: a case series. BJR Case Rep 2022; 8:20220102. [PMID: 36632552 PMCID: PMC9809910 DOI: 10.1259/bjrcr.20220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 01/14/2023] Open
Abstract
Mucinous colorectal adenocarcinoma represents a small proportion of all colorectal cancers, characterised by mucinous tumour components. While its pattern of metastatic spread differs from that of conventional colorectal adenocarcinoma, pulmonary metastases are commonly seen in both mucinous and non-mucinous types. The assessment of pulmonary nodules in the context of malignancy is a commonly encountered problem for the radiologist given the high prevalence of benign pulmonary lesions. Low density of a pulmonary nodule on CT evaluation is one of the recognised and well-documented features of benignity that is used in the radiological assessment of such nodules. We present three cases of patients with histologically proven mucinous colorectal adenocarcinoma with evidence of pulmonary metastases. In all cases, the metastases were of low density on CT and in one case were initially suspected to represent benign hamartomatous lesions. There has been little documented about the density of mucinous pulmonary metastases on CT. We suspect the low density seen in the metastases in each case is accounted for by their high internal mucinous components. The cases presented here demonstrate the importance of recognising that mucinous colorectal metastases can be of low density and therefore mimic benign pathology. This review may help the radiologist to consider shorter interval follow-up of such lesions in the context of known mucinous neoplasms, or to investigate for an extrathoracic mucinous carcinoma in the presence of multiple low-density pulmonary nodules.
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Affiliation(s)
| | - Iain T H Au-Yong
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Yutaro Higashi
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Rafael Silverman
- Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Christopher G D Clarke
- Department of Radiology, Nottingham University Hospitals NHS Trust and Honorary (Clinical) Assistant Professor, University of Nottingham School of Medicine (Orcid ID 0000-0002-8092-9877), Nottingham, United Kingdom
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14
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Guo R, Yan S, Wang F, Su H, Xie Q, Zhao W, Yang Z, Li N, Yu J. A novel diagnostic model for differentiation of lung metastasis from primary lung cancer in patients with colorectal cancer. Front Oncol 2022; 12:1017618. [PMID: 36353559 PMCID: PMC9639374 DOI: 10.3389/fonc.2022.1017618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to evaluate the 18F-FDG PET/CT in differentiating lung metastasis(LM) from primary lung cancer(LC) in patients with colorectal cancer (CRC). Methods A total of 120 CRC patients (80 male, 40 female) who underwent 18F-FDG PET/CT were included. The diagnosis of primary lung cancer or lung metastasis was based on histopathology The patients were divided into a training cohort and a validation cohort randomized 1:1. Independent risk factors were extracted through the clinical information and 18F-FDG PET/CT imaging characteristics of patients in the validation cohort, and then a diagnostic model was constructed and a nomograms was made. ROC curve, calibration curve, cutoff, sensitivity, specificity, and accuracy were used to evaluate the prediction performance of the diagnostic model. Results One hundred and twenty Indeterminate lung lesions (ILLs) (77 lung metastasis, 43 primary lung cancer) were analyzed. No significant difference in clinical characteristics and imaging features between the training and the validation cohorts (P > 0. 05). Using uni-/multivariate analysis, pleural tags and contour were identified as independent predictors. These independent predictors were used to establish a diagnostic model with areas under the receiver operating characteristic curves (AUCs) of 0.92 and 0.89 in the primary and validation cohorts, respectively. The accuracy rate of the diagnostic model for differentiating LM from LC were higher than that of subjective diagnosis (P < 0.05). Conclusions Pleural tags and contour were identified as independent predictors. The diagnostic model of ILLs in patients with CRC could help differentiate between LM and LC.
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Affiliation(s)
- Rui Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fei Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hua Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Qing Xie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- *Correspondence: Zhi Yang, ; Nan Li, ; Jiangyuan Yu,
| | - Nan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- *Correspondence: Zhi Yang, ; Nan Li, ; Jiangyuan Yu,
| | - Jiangyuan Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- *Correspondence: Zhi Yang, ; Nan Li, ; Jiangyuan Yu,
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15
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Investigation of radiomics based intra-patient inter-tumor heterogeneity and the impact of tumor subsampling strategies. Sci Rep 2022; 12:17244. [PMID: 36241749 PMCID: PMC9568579 DOI: 10.1038/s41598-022-20931-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/21/2022] [Indexed: 01/06/2023] Open
Abstract
While radiomics analysis has been applied for localized cancer disease, its application to the metastatic setting involves a non-exhaustive lesion subsampling strategy which may sidestep the intrapatient tumoral heterogeneity, hindering the reproducibility and the therapeutic response performance. Our aim was to evaluate if radiomics features can capture intertumoral intrapatient heterogeneity, and the impact of tumor subsampling on the computed heterogeneity. To this end, We delineated and extracted radiomics features of all visible tumors from single acquisition pre-treatment computed tomography of patients with metastatic lung cancer (cohort L) and confirmed our results on a larger cohort of patients with metastatic melanoma (cohort M). To quantify the captured heterogeneity, the absolute coefficient of variation (CV) of each radiomics index was calculated at the patient-level and a sensitivity analysis was performed using only a subset of all extracted features robust to the segmentation step. The extent of information loss by six commonly used tumor sampling strategies was then assessed. A total of 602 lesions were segmented from 43 patients (median age 57, 4.9% female). All robust radiomics indexes exhibited at least 20% of variation with significant heterogeneity both in heavily and oligo metastasized patients, and also at the organ level. None of the segmentation subsampling strategies were able to recover the true tumoral heterogeneity obtained by exhaustive tumor sampling. Image-based inter-tumor intra-patient heterogeneity can be successfully grasped by radiomics analyses. Failing to take into account this kind of heterogeneity will lead to inconsistent predictive algorithms. Guidelines to standardize the tumor sampling step and/or AI-driven tools to alleviate the segmentation effort are required.
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16
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Chacko SR, Matta A, Bhat R, Minimo C, Benzaquen S, Gupta E. A 62-Year-Old Immunocompromised Man With Halo Sign on Chest Imaging. Chest 2022; 162:e177-e181. [DOI: 10.1016/j.chest.2022.04.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/27/2022] [Accepted: 04/23/2022] [Indexed: 11/05/2022] Open
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17
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Liu Y, Sukumar UK, Jugniot N, Seetharam SM, Rengaramachandran A, Sadeghipour N, Mukherjee P, Krishnan A, Massoud TF, Paulmurugan R. Inhaled Gold Nano-star Carriers for Targeted Delivery of Triple Suicide Gene Therapy and Therapeutic MicroRNAs to Lung Metastases: Development and Validation in a Small Animal Model. ADVANCED THERAPEUTICS 2022; 5:2200018. [PMID: 36212523 PMCID: PMC9543365 DOI: 10.1002/adtp.202200018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pulmonary metastases pose significant treatment challenges for many cancers, including triple-negative breast cancer (TNBC). We developed and tested a novel suicide gene and therapeutic microRNAs (miRs) combination therapy against lung metastases in vivo in mouse models after intranasal delivery using nontoxic gold nanoparticles (AuNPs) formulated to carry these molecular therapeutics. We used AuNPs coated with chitosan-β-cyclodextrin (CS-CD) and functionalized with a urokinase plasminogen activator (uPA) peptide to carry triple cancer suicide genes (thymidine kinase-p53-nitroreductase: TK-p53-NTR) plus therapeutic miRNAs (antimiR-21, antimiR-10b and miR-100). We synthesized three AuNPs: 20nm nanodots (AuND), and 20nm or 50nm nanostars (AuNS), then surface coated these with CS-CD using a microfluidic-optimized method. We sequentially coated the resulting positively charged AuNP-CS-CD core with synthetic miRNAs followed by TK-p53-NTR via electrostatic interactions, and added uPA peptide through CD-adamantane host-guest chemistry. A comparison of transfection efficiencies for different AuNPs showed that the 50nm AuNS allowed ∼4.16-fold higher gene transfection than other NPs. The intranasal delivery of uPA-AuNS-TK-p53-NTR-microRNAs NPs (pAuNS@TK-p53-NTR-miRs) in mice predominantly accumulated in lungs and facilitated ganciclovir and CB1954 prodrug-mediated gene therapy against TNBC lung metastases. This new nanosystem may serve as an adaptable-across-cancer-type, facile, and clinically scalable platform to allow future inhalational suicide gene-miR combination therapy for patients harboring pulmonary metastases.
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Affiliation(s)
- Yi Liu
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, CA
| | - Uday Kumar Sukumar
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, CA
| | - Natacha Jugniot
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, CA
| | | | - Adith Rengaramachandran
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, CA
| | - Negar Sadeghipour
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, CA
| | | | - Anandi Krishnan
- Department of Pathology, School of Medicine, Stanford University, CA
| | - Tarik F. Massoud
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, CA
| | - Ramasamy Paulmurugan
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, CA
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18
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Cortopassi IO, Gosangi B, Asch D, Bader AS, Gange CP, Rubinowitz AN. Diseases of the pulmonary arteries: imaging appearances and pearls. Clin Imaging 2022; 91:111-125. [DOI: 10.1016/j.clinimag.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
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19
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Federated Learning Approach with Pre-Trained Deep Learning Models for COVID-19 Detection from Unsegmented CT images. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070958. [PMID: 35888048 PMCID: PMC9316900 DOI: 10.3390/life12070958] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 12/17/2022]
Abstract
(1) Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Reverse transcription polymerase chain reaction (RT-PCR) remains the current gold standard for detecting SARS-CoV-2 infections in nasopharyngeal swabs. In Romania, the first reported patient to have contracted COVID-19 was officially declared on 26 February 2020. (2) Methods: This study proposes a federated learning approach with pre-trained deep learning models for COVID-19 detection. Three clients were locally deployed with their own dataset. The goal of the clients was to collaborate in order to obtain a global model without sharing samples from the dataset. The algorithm we developed was connected to our internal picture archiving and communication system and, after running backwards, it encountered chest CT changes suggestive for COVID-19 in a patient investigated in our medical imaging department on the 28 January 2020. (4) Conclusions: Based on our results, we recommend using an automated AI-assisted software in order to detect COVID-19 based on the lung imaging changes as an adjuvant diagnostic method to the current gold standard (RT-PCR) in order to greatly enhance the management of these patients and also limit the spread of the disease, not only to the general population but also to healthcare professionals.
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20
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Ko JP, Bagga B, Gozansky E, Moore WH. Solitary Pulmonary Nodule Evaluation: Pearls and Pitfalls. Semin Ultrasound CT MR 2022; 43:230-245. [PMID: 35688534 DOI: 10.1053/j.sult.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung nodules are frequently encountered while interpreting chest CTs and are challenging to detect, characterize, and manage given they can represent both benign or malignant etiologies. An understanding of features associated with malignancy and causes of interpretive pitfalls is helpful to avoid misdiagnoses. This review addresses pertinent topics related to the etiologies for missed lung nodules on radiography and CT. Additionally, CT imaging technical pitfalls and challenges in addition to issues in the evaluation of nodule morphology, attenuation, and size will be discussed. Nodule management guidelines will be addressed as well as recent investigations that further our understanding of lung nodules.
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Affiliation(s)
- Jane P Ko
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY.
| | - Barun Bagga
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - Elliott Gozansky
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - William H Moore
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
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21
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Chen K, Lai YC, Vanniarajan B, Wang PH, Wang SC, Lin YC, Ng SH, Tran P, Lin G. Clinical impact of a deep learning system for automated detection of missed pulmonary nodules on routine body computed tomography including the chest region. Eur Radiol 2022; 32:2891-2900. [PMID: 34999920 DOI: 10.1007/s00330-021-08412-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the clinical impact of a deep learning system (DLS) for automated detection of pulmonary nodules on computed tomography (CT) images as a second reader. METHODS This single-centre retrospective study screened 21,150 consecutive body CT studies from September 2018 to February 2019. Pulmonary nodules detected by the DLS on axial CT images but not mentioned in initial radiology reports were flagged. Flagged images were scored by four board-certificated radiologists each with at least 5 years of experience. Nodules with scores of 2 (understandable miss) or 3 (should not be missed) were then categorised as unlikely to be clinically significant (2a or 3a) or likely to be clinically significant (2b or 3b) according to the 2017 Fleischner guidelines for pulmonary nodules. The miss rate was defined as the total number of studies receiving scores of 2 or 3 divided by total screened studies. RESULTS Among 172 nodules flagged by the DLS, 60 (35%) missed nodules were confirmed by the radiologists. The nodules were further categorised as 2a, 2b, 3a, and 3b in 24, 14, 10, and 12 studies, respectively, with an overall positive predictive value of 35%. Missed pulmonary nodules were identified in 0.3% of all CT images, and one-third of these lesions were considered clinically significant. CONCLUSIONS Use of DLS-assisted automated detection as a second reader can identify missed pulmonary nodules, some of which may be clinically significant. CLINICAL RELEVANCE/APPLICATION Use of DLS to help radiologists detect pulmonary lesions may improve patient care. KEY POINTS • DLS-assisted automated detection as a second reader is feasible in a large consecutive cohort. • Performance of combined radiologists and DLS was better than DLS or radiologists alone. • Pulmonary nodules were missed more frequently in abdomino-pelvis CT than the thoracic CT.
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Affiliation(s)
- Kueian Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | | | - Pieh-Hsu Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Shao-Chung Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Yu-Chun Lin
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Pelu Tran
- FerrumFerrum Health, Santa Clara, CA, USA
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
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22
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Validation pipeline for machine learning algorithm assessment for multiple vendors. PLoS One 2022; 17:e0267213. [PMID: 35486572 PMCID: PMC9053776 DOI: 10.1371/journal.pone.0267213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/05/2022] [Indexed: 01/15/2023] Open
Abstract
A standardized objective evaluation method is needed to compare machine learning (ML) algorithms as these tools become available for clinical use. Therefore, we designed, built, and tested an evaluation pipeline with the goal of normalizing performance measurement of independently developed algorithms, using a common test dataset of our clinical imaging. Three vendor applications for detecting solid, part-solid, and groundglass lung nodules in chest CT examinations were assessed in this retrospective study using our data-preprocessing and algorithm assessment chain. The pipeline included tools for image cohort creation and de-identification; report and image annotation for ground-truth labeling; server partitioning to receive vendor “black box” algorithms and to enable model testing on our internal clinical data (100 chest CTs with 243 nodules) from within our security firewall; model validation and result visualization; and performance assessment calculating algorithm recall, precision, and receiver operating characteristic curves (ROC). Algorithm true positives, false positives, false negatives, recall, and precision for detecting lung nodules were as follows: Vendor-1 (194, 23, 49, 0.80, 0.89); Vendor-2 (182, 270, 61, 0.75, 0.40); Vendor-3 (75, 120, 168, 0.32, 0.39). The AUCs for detection of solid (0.61–0.74), groundglass (0.66–0.86) and part-solid (0.52–0.86) nodules varied between the three vendors. Our ML model validation pipeline enabled testing of multi-vendor algorithms within the institutional firewall. Wide variations in algorithm performance for detection as well as classification of lung nodules justifies the premise for a standardized objective ML algorithm evaluation process.
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23
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Parul ., Singh PK. A Rare Etiology of Cystic Lung Disease. Cureus 2022; 14:e24334. [PMID: 35608613 PMCID: PMC9123401 DOI: 10.7759/cureus.24334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
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24
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Silva JAM, Marchiori E, Macedo FCD, Silva PRGD, Amorim VB. Pulmonary metastasis of osteosarcoma: multiple presentations in a single patient. J Bras Pneumol 2022; 48:e20210478. [PMID: 35475867 PMCID: PMC9064642 DOI: 10.36416/1806-3756/e20210478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Edson Marchiori
- . Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | | | | | - Viviane Brandão Amorim
- . Departamento de Radiologia, Instituto Nacional do Câncer, Rio de Janeiro (RJ), Brasil.,. Departamento de Radiologia, Grupo Fleury S.A., Rio de Janeiro (RJ), Brasil
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25
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Imaging Characteristics and Prognostic Value of Isolated Pulmonary Metastasis from Colorectal Cancer Demonstrated with18F-FDG PET/CT. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2230079. [PMID: 35463990 PMCID: PMC9023141 DOI: 10.1155/2022/2230079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022]
Abstract
Objective. Solitary pulmonary lesions (SPNs) in patients with a history of colorectal cancer (CRC) may be attributed to metastatic lung tumors, primary lung cancer, or benign nodules. We aimed to analyze the imaging characteristics of SPNs in CRC patients to differentiate these pulmonary nodules and evaluate the prognostic value of isolated pulmonary metastasis from CRC using 18F-FDG PET/CT. Methods. From January 2013 to January 2021, 62 CRC patients with SPNs demonstrated with 18F-FDG PET/CT were retrospectively enrolled in the present study. We compared the radiological and clinical characteristics of these patients. In addition, survival time and prognostic factors were statistically analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards models. Results. There were 33 cases of isolated lung metastasis, 20 cases of second primary lung cancer (SPLC), and nine cases of benign nodules. The proportion of nodules with a maximal diameter greater than the median value was lower in the isolated lung metastasis group compared with the SPLC group (
), showing polygonal shape, ill-defined margin, pleural indentation, air bronchogram, speculation, and ground-glass opacity. Patients with isolated lung metastasis had a significantly higher maximal diameter of lung lesion, SUVmax of lung lesion, and 18F-FDG uptake compared with the benign nodule group (
). Multivariate analysis revealed that the following two factors were significant independent predictors of PLC: air bronchogram (hazard ratio [HR] =22.327; 95% confidence interval [CI]: 1.910-261.061;
) and spiculation (HR =6.148; 95% CI 1.469-25.725;
). Initial TNM stage IV (HR =19.831, 95% CI 1.061-370.782;
) was extremely associated with a decreased lifespan of CRC patients with isolated lung metastasis. Conclusions. The result showed that CT features, including air bronchogram and spiculated margins, could be used to differentiate SPLC from single isolated lung metastasis in CRC patients. In patients with isolated lung metastasis, primary CRC TNM stage IV was associated with a poorer prognosis, and patients with such conditions might need more care.
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26
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Stechele M, Kunz WG. Air Crescent Sign in Fast-Responding Lung Metastases. Radiol Imaging Cancer 2022; 4:e220012. [PMID: 35302394 PMCID: PMC8965527 DOI: 10.1148/rycan.220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
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27
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Guarnera A, Santini E, Podda P. COVID-19 Pneumonia and Lung Cancer: A Challenge for the Radiological Review of the Main Radiological Features, Differential Diagnosis and Overlapping Pathologies. Tomography 2022; 8:513-528. [PMID: 35202206 PMCID: PMC8875889 DOI: 10.3390/tomography8010041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 pneumonia pandemic represents the most severe health emergency of the 21st century and has been monopolizing health systems’ economic and human resources world-wide. Cancer patients have been suffering from the health systems’ COVID-19 priority management with evidence of late diagnosis leading to patients’ poor prognosis and late medical treatment. The radiologist plays a pivotal role as CT represents a non-invasive radiological technique which may help to identify possible overlap and differential diagnosis between COVID-19 pneumonia and lung cancer, which represents the most frequent cancer histology in COVID-19 patients. Our aims are: to present the main CT features of COVID-19 pneumonia; to provide the main differential diagnosis with lung cancer, chemotherapy-, immunotherapy-, and radiotherapy-induced lung disease; and to suggest practical tips and key radiological elements to identify possible overlap between COVID-19 pneumonia and lung cancer. Despite similarities or overlapping findings, the combination of clinics and some specific radiological findings, which are also identified by comparison with previous and follow-up CT scans, may guide differential diagnosis. It is crucial to search for typical COVID-19 pneumonia phase progression and typical radiological features on HRTC. The evidence of atypical findings such as lymphadenopathies and mediastinal and vessel invasion, as well as the absence of response to therapy, should arouse the suspicion of lung cancer and require contrast administration. Ground-glass areas and/or consolidations bound to radiotherapy fields or pneumonitis arising during and after oncological therapy should always arouse the suspicion of radiation-induced lung disease and chemo/immunotherapy-induced lung disease. The radiological elements we suggest for COVID-19 and lung cancer differential diagnosis may be used to develop AI protocols to guarantee an early and proper diagnosis and treatment to improve patients’ quality of life and life expectancy.
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Affiliation(s)
- Alessia Guarnera
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy
- Correspondence:
| | - Elena Santini
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
| | - Pierfrancesco Podda
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
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28
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Valente T, Guarino S, Lassandro G, Picchi S, Romano F, Massimo C, Rea G, Lieto R, Nicola R, Lassandro F. Cystic lung diseases: radiological aspects. Clin Radiol 2022; 77:e337-e345. [DOI: 10.1016/j.crad.2022.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
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29
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Acquisto A, Duran Derijckere I, De Angelis R. An Atypical Behavior of Metastatic Lung Disease in a Young Woman With Osteosarcoma: A Case Report. Cureus 2022; 14:e21589. [PMID: 35228947 PMCID: PMC8873443 DOI: 10.7759/cureus.21589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/05/2022] Open
Abstract
Osteosarcoma is an aggressive primary malignant bone tumor with frequent local or metastatic recurrence after surgery. Lungs are the most common site of metastasis. Although the majority of relapses will occur within five years of the initial diagnosis of osteosarcoma, lung metastases may appear a long time after initial presentation. This mechanism is known as late-relapse metastasis, in which dormant metastatic cells undergo reactivation and give rise to metastatic outgrowths. We report a case of a 29-year-old woman diagnosed with osteosarcoma of the left distal tibia. Chest CT performed at the initial presentation showed no metastasis. The patient underwent two cycles of neoadjuvant chemotherapy prior to surgery. Routine follow-up chest CT revealed a lung nodule five years later. A sudden increase in the size of the lung nodule was observed two years later. Histopathological analysis of the lung nodule confirmed osteosarcoma lung metastasis. A better understanding of the various types of aspects and atypical behaviors of osteosarcoma metastases could have a significant impact on the prognosis of the patients.
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30
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Im Y, Lee H, Lee HY, Baek SY, Jeong BH, Lee K, Kim H, Kwon OJ, Han J, Lee KS, Ahn MJ, Kim J, Um SW. Prognosis of pulmonary lymphangitic carcinomatosis in patients with non-small cell lung cancer. Transl Lung Cancer Res 2022; 10:4130-4140. [PMID: 35004244 PMCID: PMC8674602 DOI: 10.21037/tlcr-21-677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/25/2021] [Indexed: 12/25/2022]
Abstract
Background The eighth edition of the TNM classification for lung cancer does not provide a definite guideline for pulmonary lymphangitic carcinomatosis. The purpose of this retrospective case-control study is to evaluate the prognosis of pulmonary lymphangitic carcinomatosis in patients with non-small cell lung cancer compared with those with intrapulmonary metastases. Methods Non-small cell lung cancer (NSCLC) patients with pulmonary lymphangitic carcinomatosis detected on chest computed tomography scan during staging evaluation between 2000 and 2016 were included. The extent of pulmonary lymphangitic carcinomatosis was classified as being around the primary tumor (cLy1), at a distance from the tumor but confined to the same lobe (cLy2), in other ipsilateral lobes (cLy3), or affecting the contralateral lung (cLy4). Overall survival rates of the subjects were compared with those with intrapulmonary metastases. Results A total of 103 subjects with pulmonary lymphangitic carcinomatosis were analysed. The 5-year overall survival rates of the subjects with pulmonary lymphangitic carcinomatosis (n=103) and intrapulmonary metastases (n=111) were 33% and 21%, respectively. The 5-year overall survival rates of cLy1 (n=28), cLy2 (n=40), cLy3 (n=26) and cLy4 (n=9) were 54%, 35%, 12% and 11%, respectively. On multivariable analyses after adjusting for possible confounders, the subjects with cLy1 and cLy2 had better overall survival (adjusted hazard ratio for death, 0.34 and 0.49; 95% confidence interval, 0.24-0.73 and 0.30-0.80; P<0.001 and 0.004, respectively) and the subjects with cLy4 had worse overall survival (adjusted hazard ratio, 2.21; 95% confidence interval, 1.03-4.70; P=0.040) compared with those with intrapulmonary metastases. Conclusions The subjects with cLy1/2 had better overall survival than those with cLy3/4 or intrapulmonary metastases. cLy1/2 seems to be a T descriptor (T3/4) rather than an M1 descriptor.
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Affiliation(s)
- Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyewon Lee
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun-Young Baek
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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31
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Mismetti V, Perquis MP, Hamdi L, Froudarakis ME, Vergnon JM. Pulmonary calcinosis associated with Alport syndrome. Respir Med Case Rep 2022; 39:101727. [PMID: 36060641 PMCID: PMC9428909 DOI: 10.1016/j.rmcr.2022.101727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/21/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 48-year-old woman under dialysis from chronic renal failure (CRF) since the age of 27, due to Alport syndrome. The patient underwent routine chest X-ray on which diffuse micronodules were shown. Chest computed tomography showed partially calcified micronodules with centrilobular distribution respecting the subpleural spaces and predominant in the upper lobar regions. Metastatic pulmonary calcinosis was confirmed by the bone scan with an overall course of 29 years. This is the first reported case of pulmonary calcinosis from CRF due to Alport syndrome.
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Affiliation(s)
| | | | | | - Marios E. Froudarakis
- Corresponding author. Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France.
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32
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Mancera J, Vergara A, Cadena ME, Lozada-Martinez ID, Guardo-Carmona D, Cabrera-Vargas LF, Ataullah A. Metastasis of the abdominal wall in a patient with diagnosis of pulmonary adenocarcinoma: An interesting finding. Respir Med Case Rep 2022; 38:101703. [PMID: 35879972 PMCID: PMC9307449 DOI: 10.1016/j.rmcr.2022.101703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/25/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022] Open
Abstract
Tumors of the abdominal wall are rare, divided into benign and malignant lesions that are composed of primary tumors and by the parietal invasion of intra-abdominal tumors and metastatic parietal implants. In the case of metastases in the abdominal wall, the most frequent are metastases from neoplasms of colonic origin. The case described below is that of a 68-year-old patient with a history of stage IIA left lung adenocarcinoma who received partial response radiotherapy with an indication for chemotherapy, which she refused and lost follow-up.
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33
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Goel V, Pasricha S, Pruthi M, Darlong LM. Parosteal osteosarcoma with high-grade transformation and lung metastasis after 12 years: a rare presentation. Indian J Thorac Cardiovasc Surg 2022; 38:62-66. [PMID: 34898877 PMCID: PMC8630309 DOI: 10.1007/s12055-021-01214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 01/03/2023] Open
Abstract
Parosteal osteosarcoma represents a low-grade, well-differentiated type of cortical surface osteosarcoma with a relatively better prognosis. Systemic metastasis is rare overall and occurs in 10-15% of patients only. Delayed recurrences (>5 years) of parosteal osteosarcoma are even rarer and only few isolated case reports of local recurrence with systemic metastasis occurring beyond 10 years exist in the literature. We present here a case of femoral parosteal osteosarcoma, successfully treated previously, that recurred with high-grade transformation locally and with lung metastasis after 12 years. The patient was managed by lung wedge resection followed by type A1 rotationplasty. Histopathology report confirmed evidence of high-grade transformation (de-differentiation) both locally and at the metastatic site, in view of strong CDK4 and MDM2 nuclear immuno-expression. The present report highlights the importance of long-term follow-up, even for a seemingly less aggressive osteosarcoma variant with identification of a novel pattern of lung metastasis.
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Affiliation(s)
- Vineet Goel
- Department of Thoracic Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Manish Pruthi
- Department of Orthopedic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Laleng Mawia Darlong
- Department of Thoracic Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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34
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Nunes TF, Martinho RAM, Marchiori E. Colon adenocarcinoma: an uncommon cause of calcified pulmonary metastases. J Bras Pneumol 2021; 47:e20210362. [PMID: 34932728 PMCID: PMC8836618 DOI: 10.36416/1806-3756/e20210362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro. Rio de Janeiro (RJ), Brasil
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35
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Samhouri BF, Koo CW, Yi ES, Ryu JH. Is the combination of bilateral pulmonary nodules and mosaic attenuation on chest CT specific for DIPNECH? Orphanet J Rare Dis 2021; 16:490. [PMID: 34809674 PMCID: PMC8607646 DOI: 10.1186/s13023-021-02103-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is characterized by multifocal proliferation of pulmonary neuroendocrine cells. On chest CT, DIPNECH exhibits bilateral pulmonary nodules and mosaic attenuation in most patients. We sought to: (1) assess the specificity of this pattern (i.e., bilateral pulmonary nodules together with mosaic attenuation) for DIPNECH; (2) describe its differential diagnosis; and (3) identify the clinico-radiologic features that may help prioritize DIPNECH over other diagnostic considerations. Methods We searched the Mayo Clinic records from 2015 to 2019 for patients with bilateral pulmonary nodules and mosaic attenuation on CT who had a diagnostic lung biopsy. A thoracic radiologist reviewed all CT scans. Chi-square test was used for categorical variables, and odds ratios were utilized to measure the association between certain variables and DIPNECH. Results Fifty-one patients met our inclusion criteria; 40 (78%) were females and 34 (67%) were never-smokers. Median age was 65 (interquartile range 55–73) years. Lung biopsy was surgical in 21 patients (41%), transbronchial in 17 (33%), and transthoracic in 12 (24%); explanted lungs were examined in 1 (2%). Metastatic/multifocal cancer was the most common diagnosis, and was found in 17 (33%) cases. Bronchiolitis was diagnosed in 12 patients (24%), interstitial lung disease in 10 (20%), and DIPNECH in 5 (10%). Previous diagnosis of an obstructive lung disease (odds ratio 15.8; P = 0.002), and peribronchial nodular distribution on CT (odds ratio 14.4; P = 0.006) were significantly correlated with DIPNECH. Although statistical significance was not reached, DIPNECH nodules were more likely to display solid attenuations (80% vs. 67%, P = 0.45), and were more numerous; > 10 nodules were seen in 80% of DIPNECH cases vs. 52% in others (P = 0.23). Because DIPNECH primarily affects women, we analyzed the women-only cohort and found similar results. Conclusions Various disorders can manifest the CT pattern of bilateral pulmonary nodules together with mosaic attenuation, and this combination is nonspecific for DIPNECH, which was found in only 10% of our cohort. Previous diagnosis of an obstructive lung disease, and peribronchial distribution of the nodules on CT increased the likelihood of DIPNECH vs. other diagnoses. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02103-w.
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Affiliation(s)
- Bilal F Samhouri
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Chi Wan Koo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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36
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De Lucia DR, Castaldo A, D'Agostino V, Ascione R, Pesce I, Coppola L, Catelli A, Radice L. Metastatic choriocarcinoma with hemorrhagic complications and spontaneous ovarian hyperstimulation syndrome: A case report. Radiol Case Rep 2021; 16:3868-3874. [PMID: 34703509 PMCID: PMC8526915 DOI: 10.1016/j.radcr.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 01/15/2023] Open
Abstract
Gestational choriocarcinoma is a malignant trophoblastic tumor arising from any gestational event, even with a long latency period, generally in the reproductive female. It is associated with a high level of beta-human chorionic gonadotropin. Its primary site is usually the uterus but not all patients have a detectable lesion in this site. Regression of the primary tumor after it has metastasized is not uncommon, and one-third of cases manifest as complications of metastatic disease. In this report we present an uncommon case of gestational choriocarcinoma with lung, liver and jejunal metastases at the time of diagnosis without evidence of pelvic disease, in 34-year-old woman. The main points of interest of our case were the development of the ovarian hyperstimulation syndrome with massive multicystic ovarian enlargement induced by high level of beta-human chorionic gonadotropin and the bleeding of jejunal and liver metastases, due to the high vascularity of the tumor tissue, a condition known as "Choriocarcinoma Syndrome". We will focus on the radiological findings of metastases, bleeding complications and ovarian hyperstimulation syndrome.
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Key Words
- CE-CT, Contrast Enhancement Computed Tomography
- Choriocarcinoma syndrome
- FSH, Follicle Stimulating Hormone
- Gestational choriocarcinoma
- HU, Hounsfield Unit
- Hemorrhagic metastases
- Hypervascular metastases
- LH, Luteinizing Hormone
- MIP, Maximum Intensity Projection
- MPR, Multiplanar Reconstruction
- MRI, Magnetic Resonance Imaging
- OHSS, Ovarian Hyperstimulation Syndrome
- Ovarian hyperstimulation syndrome
- TSH, Thyroid Stimulating Hormone
- US, Ultrasonography
- b-hCG, Beta Human Chorionic Gonadotropin
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Affiliation(s)
- Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Anna Castaldo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Valerio D'Agostino
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Ilaria Pesce
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Luigi Coppola
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Antonio Catelli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Leonardo Radice
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
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Morrissey SM, Zhang F, Ding C, Montoya-Durango DE, Hu X, Yang C, Wang Z, Yuan F, Fox M, Zhang HG, Guo H, Tieri D, Kong M, Watson CT, Mitchell RA, Zhang X, McMasters KM, Huang J, Yan J. Tumor-derived exosomes drive immunosuppressive macrophages in a pre-metastatic niche through glycolytic dominant metabolic reprogramming. Cell Metab 2021; 33:2040-2058.e10. [PMID: 34559989 PMCID: PMC8506837 DOI: 10.1016/j.cmet.2021.09.002] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 02/01/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
One of the defining characteristics of a pre-metastatic niche, a fundamental requirement for primary tumor metastasis, is infiltration of immunosuppressive macrophages. How these macrophages acquire their phenotype remains largely unexplored. Here, we demonstrate that tumor-derived exosomes (TDEs) polarize macrophages toward an immunosuppressive phenotype characterized by increased PD-L1 expression through NF-kB-dependent, glycolytic-dominant metabolic reprogramming. TDE signaling through TLR2 and NF-κB leads to increased glucose uptake. TDEs also stimulate elevated NOS2, which inhibits mitochondrial oxidative phosphorylation resulting in increased conversion of pyruvate to lactate. Lactate feeds back on NF-κB, further increasing PD-L1. Analysis of metastasis-negative lymph nodes of non-small-cell lung cancer patients revealed that macrophage PD-L1 positively correlates with levels of GLUT-1 and vesicle release gene YKT6 from primary tumors. Collectively, our study provides a novel mechanism by which macrophages within a pre-metastatic niche acquire their immunosuppressive phenotype and identifies an important link among exosomes, metabolism, and metastasis.
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Affiliation(s)
- Samantha M Morrissey
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, USA; Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Fan Zhang
- Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA; Jiangxi Provincial Children's Hospital, Jiangxi, Nanchang, China
| | - Chuanlin Ding
- Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Diego Elias Montoya-Durango
- Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Xiaoling Hu
- Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Chenghui Yang
- Department of Breast Surgery, Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Cancer Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China; Department of Breast Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhen Wang
- Department of Breast Surgery, Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Cancer Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Fang Yuan
- Department of Chemistry, University of Louisville, Louisville, KY, USA
| | - Matthew Fox
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Huang-Ge Zhang
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Haixun Guo
- Department of Radiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - David Tieri
- Department of Biochemistry and Molecular Genetics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville, School of Medicine, Louisville, KY, USA
| | - Corey T Watson
- Department of Biochemistry and Molecular Genetics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Robert A Mitchell
- Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Xiang Zhang
- Department of Chemistry, University of Louisville, Louisville, KY, USA
| | - Kelly M McMasters
- Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jian Huang
- Department of Breast Surgery, Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Cancer Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jun Yan
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, USA; Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA.
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A larval granuloma in the lung: An extremely rare phenomenon. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:404-407. [PMID: 34589262 PMCID: PMC8462113 DOI: 10.5606/tgkdc.dergisi.2021.20045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/16/2020] [Indexed: 12/03/2022]
Abstract
The formation of pulmonary nodules is associated with benign or malignant pathologies. Based on the sizes, growth rates, and morphological features of nodules, surgical treatment or follow-up can be performed. Pulmonary nodules are frequently encountered in the practice of thoracic surgery. A 37-year-old male patient who had a 2.0x1.9 cm nodule in the right lung was followed. His medical history revealed no chronic disease. During follow-up, the sizes of the nodule increased and, therefore, it was removed by wedge resection. The pathological examination result was reported as a larval granuloma. In conclusion, larval granulomas in the lung are extremely rare phenomena and should be further examined.
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Fernández-Arrieta A, Martínez-Jaramillo SI, Riscanevo-Bobadilla AC, Escobar-Ávila LL. Características clinicopatológicas de nódulos pulmonares: Experiencia en Clínica Reina Sofía, Bogotá, Colombia. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introducción. El cáncer de pulmón es la primera causa de mortalidad por cáncer a nivel mundial, lo que hace que sea considerado un problema de salud pública. Existen diferentes hallazgos imagenológicos que hacen sospechar la presencia de cáncer de pulmón, uno de los cuales son los nódulos pulmonares; sin embargo, estos también pueden verse en entidades benignas.
Métodos. Se incluyeron 66 pacientes con biopsia de nódulo pulmonar en la Clínica Reina Sofía, en la ciudad de Bogotá, D.C., Colombia, entre el 1° de marzo del 2017 y el 28 de febrero del 2020. Se analizaron las características demográficas de los pacientes, las características morfológicas e histopatológicas de los nódulos pulmonares y la correlación entre sus características imagenológicas e histopatológicas.
Resultados. El 69,2 % de los nódulos estudiados tenían etiología maligna, de estos el 55,5 % era de origen metástasico y el 44,5 % eran neoplasias primarias de pulmón, con patrón sólido en el 70,6 % de los casos. El patrón histológico más frecuente fue adenocarcinoma. Respecto a las características radiológicas, en su mayoría los nódulos malignos medían de 1 a 2 cm, de morfología lisa y distribución múltiple, localizados en lóbulos superiores.
Conclusiones. La caracterización de los nódulos pulmonares brinda información relevante que orienta sobre los diagnósticos más frecuentes en nuestro medio, cuando se estudian nódulos sospechosos encontrados incidentalmente o en el seguimiento de otro tumor. Como el nódulo es la manifestación del cáncer temprano del pulmón, establecer programas de tamización que permitan el diagnóstico oportuno, es hoy día una imperiosa necesidad, para reducir la mortalidad.
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Differentiating pulmonary metastasis from benign lung nodules in thyroid cancer patients using dual-energy CT parameters. Eur Radiol 2021; 32:1902-1911. [PMID: 34564746 DOI: 10.1007/s00330-021-08278-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/01/2021] [Accepted: 08/16/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To explore the importance of quantitative characteristics of dual-energy CT (DECT) between pulmonary metastasis and benign lung nodules in thyroid cancer. METHODS In this retrospective study, we identified 63 patients from our institution's database with pathologically proven thyroid cancer who underwent DECT to assess pulmonary metastasis. Among these patients, 22 had 55 pulmonary metastases, and 41 had 97 benign nodules. If nodules showed increased iodine uptake on I-131 single-photon emission computed tomography-computed tomography or increased size in follow-up CT, they were considered metastatic. We compared the clinical findings and DECT parameters of both groups and performed a receiver operating characteristic analysis to evaluate the optimal cutoff values of the DECT parameters. RESULTS Patients with metastases were significantly older than patients with benign nodules (p = 0.048). The DECT parameters of the metastatic nodules were significantly higher than those of the benign nodules (iodine concentration [IC], 5.61 ± 2.02 mg/mL vs. 1.61 ± 0.98 mg/mL; normalized IC [NIC], 0.60 ± 0.20 vs. 0.16 ± 0.11; NIC using pulmonary artery [NICPA], 0.60 ± 0.44 vs. 0.15 ± 0.11; slope of the spectral attenuation curves [λHU], 5.18 ± 2.54 vs. 2.12 ± 1.39; and Z-effective value [Zeff], 10.0 ± 0.94 vs. 8.79 ± 0.75; all p < 0.001). In the subgroup analysis according to nodule size, all DECT parameters of the metastatic nodules in all subgroups were significantly higher than those of the benign nodules (all p < 0.05). The cutoff values for IC, NIC, λHU, NICPA, and Zeff for diagnosing metastases were 3.10, 0.29, 3.57, 0.28, and 9.34, respectively (all p < 0.001). CONCLUSIONS DECT parameters can help to differentiate metastatic and benign lung nodules in thyroid cancer. KEY POINTS • DECT parameters can help to differentiate metastatic and benign lung nodules in patients with thyroid cancer. • DECT parameters showed a significant difference between benign lung nodules and lung metastases, even for nodules with diameters ≥ 3 mm and < 5 mm. • Among the DECT parameters, the highest diagnostic accuracy for differentiating pulmonary metastases from benign lung nodules was achieved with the NIC and IC, followed by the NICPA and λHU, and their cutoff values were 0.29, 3.10, 0.28, and 3.57, respectively.
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Scolnik M, Glozman L, Bar-Yoseph R, Gur M, Toukan Y, Bentur L, Ilivitzki A. Atypical pulmonary metastases in children: the spectrum of radiologic findings. Pediatr Radiol 2021; 51:1907-1916. [PMID: 33847786 DOI: 10.1007/s00247-021-05035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/01/2020] [Accepted: 02/22/2021] [Indexed: 11/27/2022]
Abstract
Pulmonary nodules present a diagnostic challenge when they appear as atypical metastases in pediatric oncology patients. Chest computed tomography (CT) is the primary imaging modality for assessing lung nodules. In pediatric populations, Wilms tumor and osteosarcoma are the cancers most likely to produce pulmonary metastasis, both typical and atypical. This pictorial essay provides a thorough description of the specific radiologic features of atypical pediatric pulmonary metastases, and their pathogenesis and differential diagnosis. We also address diagnostic approaches to incidental lung nodules in healthy children found in the literature. Our aim is to help radiologists identify atypical lung metastases on CT, ensuring that children receive prompt, and potentially lifesaving, treatment.
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Affiliation(s)
- Michal Scolnik
- Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, 8 HaAliya HaShniya Street, 3109601, Haifa, Israel
| | - Luda Glozman
- Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, 8 HaAliya HaShniya Street, 3109601, Haifa, Israel
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Lea Bentur
- The Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Anat Ilivitzki
- Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, 8 HaAliya HaShniya Street, 3109601, Haifa, Israel.
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel.
- The Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
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Adzic NM, Obradovic KV, Urban VP, Mijaljevic MB, Radmanovic BJ, Milosevic ZC. Computed tomography features of pulmonary metastases from angiosarcoma: Lessons learned from one case study. Radiol Case Rep 2021; 16:2646-2650. [PMID: 34345325 PMCID: PMC8319485 DOI: 10.1016/j.radcr.2021.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/25/2022] Open
Abstract
A distinctive feature of some angiosarcomas is that two or more atypical forms of pulmonary metastases may be detected concomitantly. In this case report, we present a 37-year-old man diagnosed with angiosarcoma of the neck, with extreme diversity of lung metastases on chest computed tomography (CT). We analyzed CT features of metastases and discussed possible reasons for their pleomorphism, as well as clinical implications of these findings.
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Affiliation(s)
- Nina M Adzic
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia
| | - Katarina V Obradovic
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia
| | - Vladimir P Urban
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia
| | - Marija B Mijaljevic
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia
| | - Branka J Radmanovic
- Institute of Oncology and Radiology of Serbia, Clinic of Surgical Oncology, Belgrade, Serbia
| | - Zorica C Milosevic
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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Fazio G, Galioto F, Ferlito A, Coronella M, Palmucci S, Basile A. Cavitated pulmonary nodules in a female patient with breast cancer: Keep in mind Serratia marcescens' infections. Respir Med Case Rep 2021; 33:101441. [PMID: 34401281 PMCID: PMC8349101 DOI: 10.1016/j.rmcr.2021.101441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/01/2021] [Accepted: 05/27/2021] [Indexed: 01/15/2023] Open
Abstract
Serratia species are gram-negative bacteria, which could be isolated from soil, water, plants, animals and air. They are responsible for a heterogeneous spectrum of diseases, affecting the central nervous system, the urinary tract, the respiratory tract and the bloodstream. Pulmonary involvement is rare and typically occurs in immunocompromised patients; radiological appearances include haemorrhagic bronchopneumonia, even with the development of pulmonary abscesses and cavitated parenchymal lesions, or diffuse alveolar damage. Concerning pulmonary cavities, the differential diagnosis should include metastatic lung nodules, rheumatoid arthritis, Langerhans cell histiocytosis, mycotic infections and septic emboli. The knowledge of these radiological features, in association with clinical history and laboratory findings, is mandatory to make the correct diagnosis, suggesting the right treatment and the adequate follow-up. We described a challenging case of a Serratia marcescens’ pulmonary infection, which occurred in a patient with breast cancer: clinical features and main imaging findings have been discussed – in order to help clinicians and radiologists in the management of the disease. Breast cancer may involve lung parenchyma with metastatic cavitated nodules. Serratia can cause cavitated pulmonary nodules. Differential diagnosis of cavitated pulmonary nodules includes infectious and non-infectious diseases. Serratia commonly causes haemorrhagic bronchopneumonia or diffuse alveolar damage.
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Zhu J, Wang X, Qu Y, Wen Z. CT-guided core needle biopsy of the lung in patients with primary malignancy suspected of lung metastasis: 5-year experience from a single institution. ACTA ACUST UNITED AC 2021; 27:534-541. [PMID: 34313240 DOI: 10.5152/dir.2021.20042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE We aimed to evaluate the diagnostic accuracy and safety profile of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) in patients with primary malignancy suspected of lung metastasis and assess possible factors associated with nondiagnostic results. METHODS All PTNBs with core needle performed in our hospital from January 2014 to January 2019 were retrospectively reviewed. Overall, 108 cases were found to have a history of primary malignancy with suspected lung metastasis. Patient demographics, lesion characteristics, procedure techniques and complications were evaluated as predictors of overall diagnosis, final diagnosis of lung metastasis, and nondiagnostic results. Statistical analysis was performed using univariate analysis. RESULTS The overall diagnostic accuracy of PTNB was 83.3%. Lung metastasis was found in 52.8% of PTNBs (57 of 108) and nondiagnostic results were present in 27.6% (18 of 108). Of the 18 cases with nondiagnostic results, 11 cases had a final diagnosis of lung metastasis (61.1%), yielding PTNB a sensitivity of 83.8% and specificity of 100% for the detection of lung metastasis. Smaller lesion size (p = 0.014), pneumothorax (p = 0.026), and hemoptysis (p = 0.014) were significantly associated with overall nondiagnostic results. Similarly, smaller lesion size (p = 0.047), pneumothorax (p = 0.019), high-grade pulmonary hemorrhage (p = 0.019), and hemoptysis (p = 0.012) were significantly correlated with unsuccessful biopsies in the diagnosis of lung metastasis. CONCLUSION CT-guided core needle biopsy of the lung in patients with primary malignancy suspected of lung metastasis has a high diagnostic accuracy with acceptable complication rates. Small lesion size, pneumothorax, high-grade pulmonary hemorrhage, and hemoptysis are significantly associated with nondiagnostic results in the final diagnosis of lung metastasis. Repeat biopsy and clinical/radiological follow-up should be considered in cancer patients with nondiagnostic results due to the high probability of lung metastasis.
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Affiliation(s)
- Jianbin Zhu
- Department of Radiology, Southern Medical University, Zhujiang Hospital, Guangdong, China
| | - Xianlong Wang
- Department of Radiology, Southern Medical University, Zhujiang Hospital, Guangdong, China
| | - Yaoming Qu
- Department of Radiology, Southern Medical University, Zhujiang Hospital, Guangdong, China
| | - Zhibo Wen
- Department of Radiology, Southern Medical University, Zhujiang Hospital, Guangdong, China
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Shroff N, Bhargava P. Metastatic Cecal Adenocarcinoma presenting as acute appendicitis. Radiol Case Rep 2021; 16:2129-2132. [PMID: 34158906 PMCID: PMC8203588 DOI: 10.1016/j.radcr.2021.04.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 12/29/2022] Open
Abstract
This case report details the findings of metastatic colon cancer in an older male patient who initially presented with signs and symptoms of acute appendicitis. The patient underwent routine CT (Computed Tomography) imaging for diagnostic evaluation of appendicitis. Subsequently, the patient was found to have findings consistent with acute appendicitis secondary to obstruction from a cecal mass with evidence of hepatic and pulmonary metastases. This case report demonstrates the radiological findings of acute appendicitis secondary to metastatic colorectal disease and highlights the importance of considering underlying malignancy in cases of appendicitis occurring in older individuals.
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Affiliation(s)
- Neel Shroff
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, 77555
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, 77555
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Adrian B, Priou P, Cadranel J, De Chabot G, Rousselet MC, Urban T, Gagnadoux F. A Case of Pulmonary Adenocarcinoma Presenting with Diffuse Cystic Lesions. Case Rep Oncol 2021; 14:896-900. [PMID: 34248557 PMCID: PMC8255696 DOI: 10.1159/000515863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 01/15/2023] Open
Abstract
The main causes of diffuse cystic lung diseases include lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, Birt-Hogg-Dubé syndrome, lymphoid interstitial pneumonia, light chain deposition disease, Pneumocystis jirovecii pneumonia, hypersensitivity pneumonitis, and desquamative interstitial pneumonia. Diffuse cystic lung diseases are rarely caused by a malignant process, which are secondary to metastases from sarcomas and gastrointestinal and gynecologic adenocarcinomas. Here, we present a rare case of invasive pulmonary adenocarcinoma associated with progressive diffusion of cystic lesions, revealed by chronic cough and progressive shortness of breath. It is important for clinicians to be aware of this unusual imaging manifestation of lung cancer, to avoid misdiagnoses.
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Affiliation(s)
- Benjamin Adrian
- Département de Pneumologie, Centre Hospitalo-Universitaire d'Angers et Université d'Angers, Angers, France
| | - Pascaline Priou
- Département de Pneumologie, Centre Hospitalo-Universitaire d'Angers et Université d'Angers, Angers, France
| | - Jacques Cadranel
- Service de Pneumologie et Oncologie Thoracique, Assistance Publique, Hôpitaux de Paris (Hôpital Tenon) and GRC#04 Theranoscan Sorbonne Université, Paris, France
| | - Gonzague De Chabot
- Département de Pneumologie, Centre Hospitalo-Universitaire d'Angers et Université d'Angers, Angers, France
| | - Marie-Christine Rousselet
- Département de Pathologie Cellulaire et Tissulaire, Centre Hospitalo-Universitaire d'Angers et Université d'Angers, Angers, France
| | - Thierry Urban
- Département de Pneumologie, Centre Hospitalo-Universitaire d'Angers et Université d'Angers, Angers, France
| | - Frédéric Gagnadoux
- Département de Pneumologie, Centre Hospitalo-Universitaire d'Angers et Université d'Angers, Angers, France
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Role of the Thoracic Radiologist in the Evaluation and Management of Solid and Subsolid Lung Nodules. Thorac Surg Clin 2021; 31:283-292. [PMID: 34304836 DOI: 10.1016/j.thorsurg.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this review, the authors describe the imaging characteristics of solid and subsolid nodules as well as their management recommendations including the use of image-guided percutaneous biopsy and preoperative coil localization. Using case presentations, they offer practical management tips for the most commonly encountered nodule nodules in a thoracic surgical practice.
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48
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Kourouni I, Abramovich CM, Tamarkin SW, Tomashefski JF, Sivak ED. A perplexing airspace: peace of mind now or later. Breathe (Sheff) 2021; 17:210017. [PMID: 34295413 PMCID: PMC8291947 DOI: 10.1183/20734735.0017-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
A 36-year-old, nonsmoking woman with a history of asthma presented for a second opinion about a “cavitating” right middle lobe (RML) lesion that was found incidentally 6 months prior, during preoperative evaluation for cholecystectomy. The lesion in question was pleural based, measuring 5.4×4×4.5 cm with thin and thick inner septations along with low-density right hilar and mediastinal adenopathy (figure 1a–c). A perplexing right middle lobe lesion in a young woman. Peace of mind now or later?https://bit.ly/3veB5wE
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Affiliation(s)
- Ismini Kourouni
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
| | - Caroline M Abramovich
- Dept of Pathology, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
| | - Stephen W Tamarkin
- Dept of Radiology, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
| | - Joseph F Tomashefski
- Dept of Pathology, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
| | - Edward D Sivak
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
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Atypical clear cell sarcoma of the pleura presenting as large pleural effusion with 22q12 abnormality: A challenging case with twists and turns. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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50
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Kato T, Hiraishi Y, Kaseda K, Suzuki S, Tanaka G, Yamauchi Y, Yasui M, Shinozaki-Ushiku A, Ushiku T, Yamaji O, O'Neal WK, Nagase T. A 79-Year-Old Man With Progressive Dyspnea and Multiple Pulmonary Nodules. Chest 2021; 158:e79-e84. [PMID: 32768080 DOI: 10.1016/j.chest.2020.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/08/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Takafumi Kato
- Departments of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan; Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yoshihisa Hiraishi
- Departments of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| | - Ken Kaseda
- Departments of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Suzuki
- Departments of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Goh Tanaka
- Departments of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasuhiro Yamauchi
- Departments of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Mariko Yasui
- Departments of Pathology, The University of Tokyo Hospital, Tokyo, Japan; Department of Pathology, School of Medicine, Teikyo University, Tokyo, Japan
| | | | - Tetsuo Ushiku
- Departments of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Osamu Yamaji
- Department of Internal Medicine, Toshima Hospital of Tokyo Metropolitan Health and Hospitals Corporation, Tokyo, Japan
| | - Wanda K O'Neal
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Takahide Nagase
- Departments of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
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