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Excavation of Metastatic Nodules in the Lung

1959; Radiological Society of North America; Volume: 72; Issue: 1 Linguagem: Inglês

10.1148/72.1.30

1527-1315

Frederick W. Deck, Robert S. Sherman,

Sarcoma Diagnosis and Treatment

Most pulmonary metastases are readily detectable by the radiologist and at the same time can usually be identified as such. Approximately 60 per cent of the secondary deposits found postmortem are said to be radiographically visible (1). Minor (2), in a study of 5,720 neoplasms, found 314 in which pulmonary metastases were demonstrated radiographically. He classified these deposits on the basis of their radiographic appearance as nodular, infiltrative, lymphangitic, miliary, and massive consolidative types. There is still much confusion in the literature about the classification of metastatic pulmonary lesions but Minor's plan appears to us to be as basic and simple as possible. While there is often some overlapping, and mixed types do occur, in any particular case the classification is made on the basis of the predominant aspect. Certain metastatic lesions present features of special interest to the radiologist. The presence of calcification in the lung metastases of some osteogenic sarcomas and chondrosarcomas lends specificity to these deposits. In a previous publication a study was made of spontaneous pneumothorax due to metastatic disease (3). It was noted that this is usually associated with sarcoma rather than carcinoma. The single nodular metastatic deposit may likewise be of particular interest, inasmuch as extirpation of this one focus may delay dissemination of the malignant process. In these cases, however, it is usually impossible roentgenographically to differentiate the metastatic nodule from a primary lung neoplasm. In the present study our interest is in excavation of nodular pulmonary metastases. This is a relatively uncommon phenomenon but one of practical importance to the diagnostic roentgenologist. Farrell (4) states that “multiple metastatic foci rarely break down.” He describes 1 case of sarcoma of undetermined origin metastatic to the lungs with roentgenographic and necropsy proof of excavation in some of the nodules. Minor reports 4 cases with excavation, for only 1 of which the primary lesion was documented, a carcinoma of the bladder. Salzman et al. (5) reported 2 cases, metastatic from seminoma of the testes and carcinoma of the pancreas, respectively. Katzev and Bass (6) document the primary in their case as carcinoma of the large bowel. The case described by Meyers and Sala (7) is interesting in that the lesion was in the left upper lobe bronchus with nodular spread to both right and left lungs and cavitation. Lichtenstein (8) mentions a sclerosing osteogenic sarcoma with massive pulmonary metastasis and excavation. Dickson and Smitham (9) report 2 and Efskind and Wexels (10) report 3 cases of Hodgkin's disease of the lung with cavitation. Our material consists of 21 cases, each with one or more chest films showing clear-cut evidence of cavitation. A number of cases were excluded because unequivocal evidence of cavitation was not present radiographically.