18F-FDG PET/CT is Valuable in Detecting Soft-tissue Metastasis of Lung Cancer

Background Soft-tissue metastasis (STM) is a relatively rare, but not exceptional, manifestation of lung cancer. Since the lesions of STM are usually asymptomatic, they are easy to miss during clinical evaluation. The aim of the study was to explore the incidence and characteristics of STM in lung cancer using fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT), and evaluate its effect on tumor staging and treatment. Methods We analyzed 4543 patients with lung cancer who underwent 18 F-FDG PET/CT in our hospital between January 2013 and September 2018. 85 were diagnosed with STM and included in the study group. Imaging characteristics, clinical symptoms, and survival time (from confirmed STM to death) were recorded for all study subjects. Results A total of 219 lesions were identified by 18 F-FDG PET/CT: 215 were detected by PET (maximum standardized uptake value = 6.12); 139 were detected by CT. Muscle STM were primarily found in the hip, upper limb muscle; whereas subcutaneous STM were mainly distributed in the chest and abdomen, back. In 68 patients (80%), STM were found incidentally during routine 18 F-FDG PET/CT staging. The lesions were symptomatic in 17 cases (20%); in 10 patients (11.8%) STM was the first manifestation. Other site metastases were detected in 79 patients (92.9%). Isolated STM were found in 6 patients (7.1%), whose tumor staging and treatment were affected by PET/CT findings. At the end of the follow-up period, 69 patients were dead (median survival time= 5.0 months) and 5 were lost to follow-up. Conclusions STM may be a sign of advanced stage and poor prognosis in lung cancer. 18 F-FDG PET/CT is highly valuable in the detection of STM, and can impact tumor staging and management of lung malignancies.

Prognostic Factors in Patients with Distant Soft Tissue Metastasis of Carcinoma: A Clinicopathological Study of 16 Cases

<b><i>Objectives:</i></b> Soft tissue metastasis (STM) is an uncommon condition in carcinoma. Although various case series related to STM have been reported, few reports have examined prognostic factors. This study aimed to evaluate the characteristics of STM and the factors affecting its prognosis. <b><i>Materials and Methods:</i></b> Patients with STM from carcinoma were retrospectively studied. The patients’ information, including age, sex, primary tumor, metastasis location, size of the metastatic tumor, presence of pain, histological classification, history of primary tumor treatment, and other metastasis at diagnosis of STM were collected and associated with prognosis. <b><i>Results:</i></b> Overall, 16 patients with a mean age of 68.7 years were evaluated. The overall survival rate was not significantly different between lung cancer and non-lung cancer patients. The overall survival rate was significantly better in patients undergoing definitive treatment for the primary tumor than in those without history of treatment (<i>p</i> = 0.046). The overall survival rate of STM patients with no metastasis was significantly better than those with other metastasis at the diagnosis of STM (<i>p</i> = 0.041). On multivariate analysis, no history of primary tumor treatment and STM without pain were risk factors for prognosis (<i>p</i> = 0.0340 and 0.0474, respectively). None of the patients who developed STM under the skin experienced pain, while 92.3% of the patients who developed STM in the deep layer had pain. <b><i>Conclusion:</i></b> The risk factors for poor diagnosis of STM were no past treatment of the primary tumor and absence of pain. STM in the deep layer is prone to pain.

Advanced Thyroid Follicular Carcinoma in a Pregnant Woman

The diagnostic and therapeutic approach for pregnant women with thyroid nodules can present a challenge, especially concerning surgical procedures. In the context of malignant diagnosis, by fine needle aspiration (FNA), during pregnancy, the uncertainty lies in performing surgery. This article reports the case of a 41-year-old pregnant woman in her first gestation, who sought medical care complaining of right shoulder pain. Imaging workup depicted the destruction of the humeral head and involvement of the surrounding soft tissue. She was 20 weeks pregnant. The histological report favored the diagnosis of malignancy and the thyroid as the primary site. At 30 weeks of gestation, the patient underwent a cesarean section, a total thyroidectomy, and total resection of the metastasis. The child was born healthy, but one year after the diagnosis, the patient died. Bone and soft tissue metastasis of thyroid neoplasms are not very common and indicate poor prognosis.