Imaging |

Pacreatic Adenocarcinoma With Lung Metastasis Presenting With Bubble-Like Lucencies on Computerized Tomography: A Case Report FREE TO VIEW

Stephanie Fountain, MD; Allen Thomas, MD
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Banner Good Samaritan Phoenix VA Medical Center, Phoenix, AZ

Chest. 2015;148(4_MeetingAbstracts):513A. doi:10.1378/chest.2267628
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SESSION TITLE: Imaging Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Bubble like lucencies on computerized tomography (CT) are seen with primary lung adencarcinomas, typically well differentiated mucinous adenocarcinoma (formerly bronchoalveolar carcinoma)(1) . Review of the literature shows case reports of metastatic pancreatic adenocarcinoma also presenting with bubble like lucencies on CT of lung (2). These finding on CT can be the first indication of metastasis after pancreaticoduodenectomy.

CASE PRESENTATION: A 66 year old male with a past medical history of pancreatic adenocarcinoma T2N1M0 was treated with a pancreaticoduodenectomy, followed with concurrent chemotherapy/radiation. Patient was monitored clinically and with PETCT every 3 months without signs of recurrent disease. Fourteen months after surgery, patient presents to the emergency department for a one month history of non productive cough. Patient denied hemoptysis, sputum production, fevers, weight loss or abdominal pain. Initial CXR demonstrated fluffy basilar infiltrates with possible air-fluid level at right costophrenic angle. CT Chest demonstrated multiple areas of focal infiltration with ground glass and solid components with cystic "bubble like" lucencies. CT-guided lung biopsy demonstrated focal glandular ectasia consistent with moderately differentiated adenocarcinoma of pancreatic origin.

DISCUSSION: Pancreatic adencarcinoma is the 4th leading cause of cancer deaths in America with a 5 year survival rate less than 15%. Pancreaticoduodenectomy remains the mainstay of treatment for those without obvious metastases or vascular invasion at diagnosis. This case demonstrates that distant metastases are often silent on diagnosis. Metastases to the lung can have a similar radiological appearance to primary lung adenocarcinoma with bubble like lucencies (3). This is likely because of a similar pathogenesis with over production of mucin creating cystic components.

CONCLUSIONS: The differential of bubble like lucencies on CT scan of lungs should include metastatic pancreatic adenocarcinoma.

Reference #1: Tang ER, Schreiner AM, Pua BB. Advances in lung adenocarcinoma classification: a summary of the new international multidisciplinary classification system (IASLC/ATS/ERS). Journal of Thoracic Disease. 2014;6(Suppl 5):S489-S501. doi:10.3978/j.issn.2072-1439.2014.09.12.

Reference #2: Mito K1, Yamakami Y, Kashima K, Mizunoe S, Tokimatsu I, Ichimiya T, Hiramatsu K, Nagai H, Kadota J, Nasu M. A case of suspected lung metastasis of pancreatic carcinoma with bronchorrhea similar to bronchioloalveolar carcinoma. Nihon Kokyuki Gakkai Zasshi. 2002 Aug;40(8): 666-70.

Reference #3: Patsios D1, Roberts HC, Paul NS, Chung T, Herman SJ, Pereira A, Weisbrod G. Pictorial review of the many faces of bronchioloalveolar cell carcinoma. Br J Radiol. 2007 Dec;80(960): 1015-23.

DISCLOSURE: The following authors have nothing to disclose: Stephanie Fountain, Allen Thomas

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