Lung Cancer: Student/Resident Case Report Poster - Lung Cancer I |

Missed Diagnosis: Metastatic Mesenchymal Chondrosarcoma (MC) Presenting as a Diffuse Calcified Pulmonary Nodule FREE TO VIEW

Ali Chaudhry, MD; Dana Perrone, DO; Hammad Bhatti, MD; Sayed Ali, MD
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University of Central Florida, Kissimmee, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):741A. doi:10.1016/j.chest.2016.08.836
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Calcified pulmonary nodules are often benign in nature, but can seldom be a manifestation of a variety of neoplasms. We present one such rare case.

CASE PRESENTATION: A 53 year old man with a history of hypertension, presented to our clinic with a progressive non-productive cough for 6 months. Eight years ago, persistent left ankle pain eventually led to a diagnosis of MC, requiring extensive surgery. Follow up surveillance imaging picked up a 0.5 cm diffuse calcified lung nodule. A few years later, a lesion on his sacrum was discovered and a biopsy confirmed recurrence of MC. He was placed on chemotherapy for his metastatic disease. His lung nodule, initially felt to be benign, over the course of five years, grew significantly measuring 1.9cm X 2.8 cm (Figure 1). A biopsy was deferred after an informed discussion with the patient. A PET CT also failed to show FDG uptake. Based on his history, clinical presentation and radiological growth of the calcified pulmonary nodule, he was finally diagnosed with pulmonary metastatic MC.

DISCUSSION: MC is a rare but aggressive form of tumor representing about 2% of all chondrosarcomas arising in the osseous tissue of the adult skeleton.1,2 Diagnosis is usually made based on clinical, radiological and histopathological features. 2 MCs are relatively chemo-resistant and the role of radiation remains unclear. However some studies have suggested surgical excision, chemotherapy, and radiation in treating and preventing recurrence and metastasis. Osteogenic sarcoma, chondrosarcoma, synovial sarcoma, and giant cell tumors have been known to present as calcified lung nodule. Similarly certain carcinomas (papillary and mucinous adenocarcinomas) can present as calcified lung metastases. The mechanism for calcification include: dystrophic calcification, bone formation, calcification of tumor cartilage, and mucoid calcification.3 The pattern of calcification although helpful can sometimes be misleading as in this case.

CONCLUSIONS: Calcified pulmonary metastasis can often be mistaken for benign lesions such as granulomas or hamartomas. In the appropriate setting, a high clinical suspicion should always be entertained.

Reference #1: Bishop MW, Somerville JM, Bahrami A, Kaste SC et.al. Mesenchymal Chondrosarcoma in Children and Young Adults: A Single Institution Retrospective Review. Sarcoma 2015:1-6

Reference #2: Gupta SR, Saran RK, Sharma P, Urs AB. A Rare Case of Extraskeletal Mesenchymal Chondrosarcoma with Dedifferentiation Arising from the Buccal Space in a Young Male. J Maxillofac Oral Surg 2015, 14:s293-s299

Reference #3: Charles W. Maile, M.D., Bruce A. Rodan, M.D., J. David Godwin.et.al Calcification in pulmonary metastases. 1982, British Journal of Radiology, 55, 108-113

DISCLOSURE: The following authors have nothing to disclose: Ali Chaudhry, Dana Perrone, Hammad Bhatti, Sayed Ali

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