Pulmonary Metastases

Chest Imaging ◽  
2019 ◽  
pp. 295-299
Author(s):  
Tyler H. Ternes
Keyword(s):  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Lung Parenchyma ◽  
Ground Glass Attenuation ◽  
Common Causes ◽  
Endobronchial Lesion ◽  
Lymphangitic Carcinomatosis ◽  
Lung And Kidney ◽  
Interlobular Septal Thickening

Pulmonary metastases represent spread of malignancy to the lung parenchyma. Patients with metastatic disease may present with dyspnea, cough, or hemoptysis. Alternatively, affected patients may be asymptomatic. The lungs are a common site for metastatic disease. Relatively common primary malignancies (breast, colon, lung, and kidney cancers) are the most common causes of pulmonary metastases. However, less common primary malignancies (choriocarcinoma, testicular cancers, melanoma, and sarcomas) have a higher likelihood to produce lung metastases. The vast majority of pulmonary metastases spread via the bloodstream. Hematogenous metastases are typically basilar predominant lung nodules. Metastatic nodules may be very small (miliary, < 3mm), or very large (cannonball), and may rarely be solitary. The presence of surrounding ground-glass attenuation (CT-Halo sign) often indicates surrounding hemorrhage. Some metastases may be cavitary or calcified. Pulmonary metastases may spread via the lymphatics. Asymmetric smooth or nodular interlobular septal thickening should raise concern for lymphangitic carcinomatosis. An uncommon mechanism is spread within the airways, which may result in an endobronchial lesion or post obstructive atelectasis.

ISOLATED PULMONARY METASTASES: EVOLUTION OF THE TREATMENT TECHNOLOGIES

2019 ◽  
Vol 65 (5) ◽  
pp. 645-652
Author(s):  
Aleksandr Mikhnin ◽  
T. Van ◽  
Tatyana Dubinina ◽  
Oleg Mamontov ◽  
Yelena Levchenko ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Regional Chemotherapy ◽  
High Dose ◽  
Primary Cancer ◽  
Isolated Lung ◽  
Metastatic Lung ◽  
Long Time ◽  
Treatment Technologies

The lung is the most commonly attacked organ in metastatic disease. In many patients who were successfully cured of primary cancer, pulmonary metastases for a long time may be the only, and sometimes the final manifestation of the disease. This kind of dissemination is known as isolated lung metastases. The prognosis for untreated patients with pulmonary metastases is unfavorable: 5-year survival does not exceed 5%. This survey considers the evolution of technologies for the treatment of isolated metastatic lung lesions from surgical metastasectomy to combined methods of high-dose regional chemotherapy.

Multidisciplinary management of pancreatic adenocarcinoma with isolated pulmonary metastases.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 384-384
Author(s):  
Supriya K. Jain ◽  
Cheryl Meguid ◽  
Stephen Leong ◽  
Barish H. Edil ◽  
Martin McCarter ◽  
...  
Keyword(s):  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Median Number ◽  
Metastatic Pancreatic Adenocarcinoma ◽  
Isolated Lung ◽  
Investigational Agents ◽  
Long Term Survivors

384 Background: Metastatic pancreatic adenocarcinoma (PAC) with isolated pulmonary metastases has recently been associated with prolonged overall survival. The purpose of this study was to review multi-disciplinary management and outcomes of these patients. Methods: Patients with PAC with pulmonary-only metastases were queried between 2012 to 2015 from a prospective single-institutional database. Results: Ten patients (median age: 71 yrs) were identified. Median number of lung metastases at diagnosis was 3 (range: 1 to innumerable). Seven patients had biopsy-proven lung metastases. Five presented with synchronous metastatic disease and five developed metachronous lung metastases as their first site of progression. Median time to progression between diagnosis of primary cancer to diagnosis of pulmonary metastases was 15 months (range: 4 to 31). Seven patients are alive as of this analysis. Median overall survival (OS) of this series (including two patients diagnosed 3 and 6 months ago) is 17 months, with longest overall survival = 40+ months (patient is still alive). All patients received gemcitabine-based chemotherapy; however, systemic regimens differed and included investigational agents. 3 of 5 patients with metachronous metastases underwent pancreaticoduodenectomy and are long-term survivors (34-40+ months). 2 of these 3 patients had diagnostic VATS of lung metastases and are alive with overall survival of 36+ months (resection of 2/3 nodules) and 34+ months (resection of all visible disease). Two patients with metachronous disease underwent neoadjuvant chemotherapy and pancreatic SBRT with progression to lung prior to planned surgery (OS: 30 months (deceased) and 6+ months (recently diagnosed)). 0 of 5 patients with synchronous metastatic disease had surgical resection; 3 of 5 received pancreatic SBRT. 3 of 10 patients are deceased due to visceral disease (14 months), pulmonary failure (18 months), and unknown causes (30 months). Conclusions: We report a recent single-institutional series of PAC with isolated lung metastases. Our data support that metastatic PAC patients with isolated pulmonary metastases have prolonged overall survival and suggest that local intervention may be beneficial.

scholarly journals Minimally Invasive Local Treatments for Bone and Pulmonary Metastases

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Meena Bedi ◽  
David M. King ◽  
Sean Tutton
Keyword(s):  
Minimally Invasive ◽  
Bone Metastases ◽  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Alternative Therapies ◽  
Minimally Invasive Techniques ◽  
Invasive Techniques

Surgery and chemotherapy have historically been the mainstay of treatment in patients with metastatic disease. However there are many alternative therapies available to relieve the symptoms and morbidity of metastases. In this paper, we review the role and highlight the advantages of minimally invasive techniques employed in patients with pulmonary and bone metastases.

scholarly journals Breast Cancer Cell Re-Dissemination from Lung Metastases—A Mechanism for Enhancing Metastatic Burden

2021 ◽  
Vol 10 (11) ◽  
pp. 2340
Author(s):  
Lucia Borriello ◽  
John Condeelis ◽  
David Entenberg ◽  
Maja H. Oktay
Keyword(s):  
Breast Cancer ◽  
Cancer Cells ◽  
Cancer Cell ◽  
Metastatic Disease ◽  
Breast Cancer Cells ◽  
Lung Metastases ◽  
Primary Tumors ◽  
Metastatic Burden ◽  
First Time ◽  
Do So

Although metastatic disease is the primary cause of mortality in cancer patients, the mechanisms leading to overwhelming metastatic burden are still incompletely understood. Metastases are the endpoint of a series of multi-step events involving cancer cell intravasation, dissemination to distant organs, and outgrowth to metastatic colonies. Here we show, for the first-time, that breast cancer cells do not solely disseminate to distant organs from primary tumors and metastatic nodules in the lymph nodes, but also do so from lung metastases. Thus, our findings indicate that metastatic dissemination could continue even after the removal of the primary tumor. Provided that the re-disseminated cancer cells initiate growth upon arrival to distant sites, cancer cell re-dissemination from metastatic foci could be one of the crucial mechanisms leading to overt metastases and patient demise. Therefore, the development of new therapeutic strategies to block cancer cell re-dissemination would be crucial to improving survival of patients with metastatic disease.

581 Effects of acoustic immune priming with low-intensity focused ultrasound (LOFU) and trabectedin on a murine model of osteosarcoma

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A616-A616
Author(s):  
Shannon Keisling
Keyword(s):  
Radiation Therapy ◽  
Heat Shock ◽  
Combination Therapy ◽  
Murine Model ◽  
Heat Shock Response ◽  
Cell Activation ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Therapy Group ◽  
Shock Response

BackgroundOsteosarcoma is the most common primary bone tumor and has a peak incidence in adolescence. The prognosis for recurrent and metastatic disease is poor and over one-third of patients with localized disease at presentation will recur after treatment with metastases. LOFU produces non-lethal, transient mechanical and thermal stress to cause protein misfolding, endoplasmic reticulum stress, and induction of the heat shock response (refs). Trabectedin is directly tumoricidal through inhibiting transcription and DNA repair, modulates the tumor microenvironment by selectively depleting M2 macrophages, and inhibits the transcription factor heat shock factor 1 (HSF1) (refs). We hypothesized that combination therapy would synergistically intensify the unfolded protein response and heat shock response to facilitate antigen presenting cell activation and efficient presentation to cytotoxic T cells. To examine this, experiments are being conducted to investigate the effect of LOFU in combination with trabectedin and/or radiation therapy (RT) in a murine model of osteosarcoma.MethodsPalpable (<5 mm) subcutaneous K7M2 murine osteosarcoma tumors in BALB/c mice were treated with a) LOFU, b) trabectedin (intravenous (IV) or intratumoral (IT)), c) LOFU + trabectedin, and d) radiation. Tumor growth (ANOVA (Kruskal-Wallis) with Dunn’s test for multiple comparisons), pulmonary metastases (Fisher’s exact test) and survival (Kaplan-Meier) were measured and analyzed in GraphPad Prism.ResultsMean tumor volume in the combination therapy group (428 mm3) was less than nontreated controls (887 mm3), LOFU alone (670 mm3), trabectedin alone (1218 mm3, p=0.0386). Radiation therapy resulted in complete ablation of the tumors. None of the combination therapy mice had grossly detectable lung metastases at time of death but metastases were present in the trabectedin only (20%), LOFU only (50%), and control (50%) groups (not statistically significant).ConclusionsCombination therapy with trabectedin and LOFU yielded smaller tumor size and fewer pulmonary metastases compared to individual therapies alone.

scholarly journals Role of Thermal Ablation in Colorectal Cancer Lung Metastases

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 908
Author(s):  
Alexandre Delpla ◽  
Thierry de Baere ◽  
Eloi Varin ◽  
Frederic Deschamps ◽  
Charles Roux ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Thermal Ablation ◽  
Medical Oncology ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Stereotactic Ablative Radiotherapy ◽  
Chest Drainage ◽  
Results Of Surgery

Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.

scholarly journals Interstitial syndrome-lung ultrasound B lines: a potential marker for pulmonary metastases? A case series

2018 ◽  
Vol 12 (3) ◽  
pp. 223-226 ◽  
Author(s):  
Maria Viviana Carlino ◽  
Costantino Mancusi ◽  
Giovanni De Simone ◽  
Filomena Liccardi ◽  
Mario Guarino ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Point Of Care ◽  
Case Series ◽  
Point Of Care Ultrasound ◽  
Interstitial Syndrome ◽  
Potential Marker ◽  
Bilateral Lung ◽  
Enhanced Computed Tomography

Four patients presented to the Emergency Department with dyspnea and they underwent point-of-care ultrasound. Lung ultrasound showed a diffuse bilateral B-profile pattern-interstitial syndrome, they underwent contrast-enhanced computed tomography scan of thorax that showed multiple bilateral lung metastases. The detection, in a dyspneic patient, of a diffuse Bprofile pattern not attributable to traditional interstitial syndrome conditions (pulmonary fibrosis, acute respiratory distress syndrome, acute pulmonary edema, interstitial pneumonia) could be indicative of multiple pulmonary metastases.

scholarly journals Case Report: Bilateral Pneumothoraces Due To Targeted Tumor Therapy With Regorafenib in a Young Woman With Metastatic Colorectal Cancer

2021 ◽  
Author(s):  
Tobias Rachow ◽  
Tim Sandhaus ◽  
Thomas Ernst ◽  
Helmut Schiffl ◽  
Susanne M. Lang
Keyword(s):  
Colorectal Cancer ◽  
Chest Pain ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Tumor Therapy ◽  
Tension Pneumothorax ◽  
Cancer Case ◽  
Pretreated Patient ◽  
Breath Sounds ◽  
The Right

Abstract Background: Colorectal cancer is one of the most common cancer types, frequently metastasizing into the lungs. Treatment options have been vastly improved over the last years. With the increasing use of targeted therapies novel and rare adverse effects can be seen. In this report, we present the case of recurrent spontaneous bilateral pneumothorax due to fulminant tumor necrosis during the administration of regorafenib in a heavily pretreated patient with multiple lung metastases from colorectal cancer. Case presentation: A 43-year-old woman presented in our oncology department with chest pain and dyspnea. The patient was diagnosed with colorectal cancer seven years earlier and had received chemoradiation, surgery and multiple chemotherapies, before she was started on regorafenib because of progressive pulmonary metastases. Clinical examination revealed no breath sounds in the right hemithorax. The patient was tachycardic and orthopneic. Computed tomography scans demonstrated cavitation of former nodular bilateral pulmonary metastases. After drainage and resolution of the right-sided pneumothorax the patient returned eleven days later with recurrent dyspnea, chest pain and subcutaneous emphysema. Bilateral pneumothoraces were treated with chest tubes. Due to left-sided tension pneumothorax video-assisted thoracoscopy and bilateral pleurodeses were performed. Persistent air leaks with severe pain and pulmonary infiltrates led to the death of the patient. Conclusions: Our case illustrates the effectiveness of regorafenib in a highly pretreated patient. However, in our patient the ensuing cavitation of the multiple nodes led to recurrent pneumothoraces and associated infectious complications. Therefore, special surveillance should be implemented to detect potential transformation of solid pulmonary metastases during treatment with this multi-kinase inhibitor.

Pituitary Disorders

2016 ◽  
pp. 191-202
Author(s):  
Pankaj Shah
Keyword(s):  
Metastatic Disease ◽  
Anterior Pituitary ◽  
Pituitary Tumors ◽  
Pituitary Hormones ◽  
Pituitary Cells ◽  
Pituitary Disease ◽  
Tissue Resistance ◽  
Common Causes ◽  
Sheehan Syndrome ◽  
Pituitary Infarction

Hypopituitarism usually results from a deficiency of anterior pituitary hormones or, rarely, from tissue resistance to these hormones. Deficiency may be from primary pituitary disease, pituitary stalk disorders, hypothalamic disease, or an extrasellar disorder impinging on, or infiltrating, the hypothalamic-pituitary unit. Primary pituitary disease results from the loss of anterior pituitary cells and may be congenital or acquired. Common causes are pituitary tumors and their surgical or radiotherapeutic ablation. Infrequent causes include pituitary infarction (eg, postpartum pituitary necrosis, also known as Sheehan syndrome), pituitary apoplexy, lymphocytic hypophysitis, infiltrative diseases (eg, hemochromatosis), and metastatic disease (eg, from breast or lung).

scholarly journals Pulmonary metastases in differentiated thyroid cancer: efficacy of radioiodine therapy and prognostic factors

2015 ◽  
Vol 173 (3) ◽  
pp. 399-408 ◽  
Author(s):  
Hong-Jun Song ◽  
Zhong-Ling Qiu ◽  
Chen-Tian Shen ◽  
Wei-Jun Wei ◽  
Quan-Yong Luo
Keyword(s):  
Thyroid Cancer ◽  
Prognostic Factors ◽  
Pulmonary Metastasis ◽  
Differentiated Thyroid Cancer ◽  
Radioiodine Therapy ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Whole Body ◽  
Metastatic Node ◽  
Serum Thyroglobulin

ContextData from a large cohort of patients with pulmonary metastases from differentiated thyroid cancer (DTC) were retrospectively analyzed.ObjectiveTo assess the effect of radioiodine therapy and investigate the prognostic factors of survival for patients with pulmonary metastasis secondary to DTC.MethodsA total of 372 patients with pulmonary metastasis from DTC treated with131I entered the study. According to the results of131I whole-body scan (WBS), pulmonary metastases were classified as131I-avid and non-131I-avid. For patients with131I-avid lung metastases, treatment response was measured by three parameters: serum thyroglobulin (Tg) levels, chest computed tomography (CT) and post-therapeutic131I-WBS. Overall survival was calculated by the Kaplan–Meier method. Factors predictive of the outcome were determined by multivariate analyses.ResultsAmong patients demonstrating131I-avid pulmonary metastases (256/372, 68.8%), 156 cases (156/256, 60.9%) showed a significant decrease in serum Tg levels after131I therapy and 138 cases (138/229, 60.3%) showed a reduction in pulmonary metastases on follow-up CT. A complete cure, however, was only achieved in 62 cases (62/256, 24.2%). Multivariate analysis showed that only age, the presence of multiple distant metastases and pulmonary metastatic node size were significant independent variables between the groups of131I-avid and non-131I-avid.ConclusionThis study indicated that, most131I-avid pulmonary metastases from DTC can obtain partial or complete remission after131I therapy. Younger patients (<40 years old) with only pulmonary metastases and small (‘fine miliaric’ or micronodular) metastases appear to have relative favorite outcomes. Patients who do not respond to131I treatment have a worse prognosis.

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