Unusual case of cavitary lung metastasis from squamous cell carcinoma of the uterine cervix

Abstract

Spontaneous excavation of primary lung cancer is common; however cavitation of metastatic lung lesions is rare and usually confused with benign lesions. In Moroccan context tuberculosis is the first suspected diagnosis of lung excavations. We report a rare case of cavitary lung metastasis of a uterine cervix cancer, treated initially as tuberculosis. A 40-year old non-smoking woman with a known history of squamous cell carcinoma of the uterine cervix since August 2005; presented on September 2008 with right chest pain without fever, hemoptysis or weight loss. CT scan showed a thin walled cavity. Empirical Antibiotic therapy was conducted 15 days with poor outcome. Then antibacillary treatment was started with no proof of mycobacterial infection. A month later, the patient presented with gynecological bleeding and a pneumothorax. Bronchoscopy with transbronchial biopsy of the cavitary mass was performed. Pathology demonstrated a metastatic squamous cell carcinoma. Pelvic examination and MRI showed a subsequent local cervix recurrence. Patient underwent 3 courses of systemic chemotherapy. She died on June 2009 due to progressive disease. Even cavitary lung metastases are rare and benign differential diagnosis are more common, clinician should be careful in neoplastic context and investigation should be done to eliminate a recurrence.

Solitary thin-walled cystic lung cancer with extensive extrapulmonary metastasis

“…[ 17 ] Spontaneous formation of cavity in metastatic lung lesions is rare. [ 21 ] Percutaneous needle washing and aspiration of cavitary lesions for cytological examination may be useful for diagnosis. [ 22 ] Radiological features including single thin-walled cavity accompanied by uneven thickening of the cavity wall or wall nodules, increased SUV by FDG-PET, and compartments in the cavity on CT images probably indicate lung cancer.…”

Cavitating Pulmonary Metastases from a Renal Cell Carcinoma

“…Despite starting systemic chemotherapy, the patient died nine months later. 6 This case portrays the importance of not undermining the malignant potential of a newly found cavitary lesion. Although the most common causes might be related to an infectious cause, it is essential also procedurally to rule out malignant process, since missing such a diagnosis can be fatal for the patient.…”

Malignant melanoma with cavitary pulmonary metastasis: Diagnostic dilemma resolved by FDG PET/CT guided biopsy

“…[ 3 ] Cavitary lung metastases are extremely rare and represent only 4% of cases of lung metastases and usually arise from squamous cell carcinoma (especially of the head and neck), adenocarcinomas, and sarcomas. [ 4 ] FDG PET is useful in the initial staging of patients with cutaneous malignant melanoma to help detect soft tissue, lymph node, and visceral metastases. [ 5 ] In a meta-analysis comparing ultrasonography (USG), CT, and PET/CT for staging and surveillance of melanoma patients, USG was found superior for the detection of lymph node metastases while PET/CT was found superior for distant metastases.…”