Whole-brain irradiation with simultaneous integrated boost by helical tomotherapy for multiple brain metastases:dosimetric and clinical analyses / 中华放射肿瘤学杂志

Objective To retrospectively analyze the dosimetry and efficacy of whole-brain irradiation (WBRT) with simultaneous integrated boost (SIB) by helical tomotherapy (HT) in the treatment of multiple brain metastases (BMs),and to evaluate the feasibility,efficacy,and safety of HT.Methods From 2014 to 2017,a total of 43 patients with multiple BMs (no less than 3 lesions) were enrolled as subjects.A dose of 40 Gy was delivered to the whole brain in 20 fractions,while a dose of 60 Gy was delivered to the gross target volume (GTV) in 20 fractions.Patients were reexamined by magnetic resonance imaging during treatment.The radiation field would be shrunk if GTV was reduced.Target coverage (TC),conformity index (CI),prescription isodose/target volume (PITV) ratio,and homogeneity index (HI) were assessed.Clinical indices included local recurrence-free survival (LRFS),intracranial progression-free survival (IPFS),progression-free survival (PFS),overall survival (OS),and toxicities.Results The median lesion number was 6(3-36) and the median total volume of GTV was 8.74 cm3.The TC,CI,PITV,and HI for GTV were 0.96±0.028,0.51±0.164,2.09±1.245,and 0.12±0.066,respectively,while the TC and HI for the whole brain were 0.95±0.033 and 0.43±0.161,respectively.In all the patients,26％ had replarming during treatment.The two-stage treatment reduced the radiation dose to organs at risk.The 1-year LRFS,IPFS,PFS,and OS rates were 96％,80％,39％,and 86％,respectively.No grade ≥3 toxicities were observed.Conclusions WBRT with SIB by HT achieves satisfactory conformity,homogeneity,efficacy,and safety,which is a recommended treatment plan for multiple BMs.Replanning during treatment can better protect normal tissue.

MRI diagnosis of atypical solitary metastatic malignant melanoma in spine: Differentiation from spinal hemangioma / 中国介入影像与治疗学

Objective To evaluate the value of MRI performance for the differential diagnosis of atypical solitary metastatic malignant melanoma from spinal hemangioma.Methods Thirteen patients of atypical solitary metastatic malignant melanoma and 40 patients of spinal solitary hemangioma were retrospectively analyzed.Conventional MR imaging (T1WI,T2WI,and fat suppressed T2WI) and enhanced imaging were performed at 1.5T MRI.The signal intensities (SIs) of spinal lesions were qualitatively evaluated on conventional imaging and were described as hypointense,isointense,or hyperintense.The spinal lesions were qualitatively categorized into minimal enhancement,iso-enhancement,slightly hyper-enhancement,or strong enhancement on contrast-enhanced imaging.The lesions' maximum diameter was also measured and the mean value was obtained.Results The qualitative assessment of SIs on T1WI showed that 76.92％ (10/13),15.38％ (2/13) and 7.69 ％ (1/13) of atypical solitary metastatic malignant melanoma were hypointensity,isointensity and hyperintensity respectively.The qualitative evaluation of SIs on T2WI were found that 61.54％ (8/13) of atypical solitary metastatic malignant melanoma with hypointense,30.77％ (4/13) with isointensity and 7.69％ (1/13) with hyperintensity,respectively.About 92.31％ (12/13) of atypical solitary metastatic malignant melanoma displayed strong enhancement on contrast-enhanced imaging.There were significant differences in SIs on T1WI,T2WI and contrast-enhanced imaging between atypical solitary metastatic malignant melanoma and hemangioma (all P＜0.05).The maximum diameter of atypical solitary metastatic malignant melanoma was significantly higher than that of spinal hemangioma (P＜0.001).Conclusion MR imaging would be practicable for differentiation between atypical solitary metastatic malignant melanoma and hemangioma in spine.

Correlation between characteristics of intracranial lesions and level of cognitive function in patients with an initial diagnosis of brain metastases / 中华放射肿瘤学杂志

Objective To investigate the correlation between the characteristics of intracranial lesions and the level of cognitive function in patients with an initial diagnosis of brain metastases.Methods A retrospective analysis was performed in 51 patients with an initial diagnosis of brain metastases who were admitted to The Second Hospital Affiliated to Suzhou University from January 2015 to April 2016.CT and (or) MRI were used to determine the characteristics of intracranial lesions and the Montreal Cognitive Assessment was used to evaluate the cognitive function of patients.Comparison between groups was made by Mann-Whitney U test.The correlation between ranked data was analyzed by Spearman rank correlation test.Results Of the 51 patients with an initial diagnosis of brain metastases,47(92%) had cognitive impairment,including mild cognitive impairment in 31(61%) and dementia in 16(31%).There was no significant difference in level of cognitive function between the patients with involvement of the left hemisphere alone and those with involvement of the right hemisphere alone (P=0.425).The patients with involvement of both hemispheres had a significantly lower level of cognitive function than those with involvement of the left hemisphere alone (P=0.042).The patients with involvement of three or more brain lobes had a significantly lower level of cognitive function than those with involvement of one or two brain lobes (P=0.015,0.024).The intracranial lesion volume and edema volume had no significant effect on the overall cognitive function of patients (P=0.077,0.178).The patients with>3 intracranial lesions had a significantly lower level of cognitive function than those with 1-3 intracranial lesions (P=0.010).Conclusions More than 90% of patients with an initial diagnosis of brain metastases have cognitive impairment.Cognitive impairment is mainly associated with lesion site,involvement of brain lobes,and number of lesions,but not with lesion volume and edema volume.

Research progress of CD147 expression in the bone metastases of tumors / 肿瘤研究与临床

CD147,which belongs to the immunoglobulin superfamily,is widely expressed in human cells and tissues and is involved in various physiological processes.CD147 has been confirmed as an increased expression in a variety of tumor cells both in vitro and in vivo.It regulates the tumor invasion,metastasis,and the activation of osteoclasts in the process of bone metastasis.Its relationship with bone metastases is one of the hot spots of tumor cell biology research field recently.

The role of stereotactic radiation therapy and whole-brain radiotherapy in the treatment of multiple brain metastases / 中华放射肿瘤学杂志

ObjectiveTo summarize the results of stereotactic radiation therapy (SRT) with or without whole-brain radiotherapy (WBRT) in the treatment of multiple brain metastasis.MethodsFrom May 1995 to April 2010,totally 98 newly diagnosed multiple (2 - 13 lesions) brain metastases patients were treated in our centre.Forty-four patients were treated with SRT alone and 54 with SRT + WBRT.Dose fractionation schemes were 15 -26 Gy in 1 fraction or 24.0 -52.5 Gy in 2 - 15 fractions with 3.5 - 12.0 Gy per fraction,depending on the tumor volume,location,and history of prior irradiation.Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis.The median age of the whole group was 55 years.The survival time was calculated from the date of radiation treatment to the day of death by any cause.ResultsThe median follow-up time for the whole group was 12 months,and the follow-up rate was 100％.The median overall survival time was 13.5 months for the whole group,there was no difference between SRT alone group and SRT + WBRT group ( 13.0 months vs.13.5 months,χ2 =0.31,P =0.578 ).The Karnofsky Performance Score ( KPS) at the time of treatment ( χ2 =6.25,P =0.012 ),the interval between the diagnosis of the primary tumor and brain metastases ( χ2 =7.34,P =0.025 ) and the status of extracranial metastases ( χ2 =4.20,P =0.040) were independent prognosis factors for survival in multivariate analyses.ConclusionsStereotactic radiation therapy is an effective and alternative treatment choice for multiple brain metastases.

Fractionated stereotactic radiotherapy for recurrent small cell lung cancer brain metastases after whole brain radiotherapy / 中华放射肿瘤学杂志

Objective Evaluation the Fractionated Stereotactic Radiotherapy (FSRT) for the patients with small-cell lung cancer (SCLC) after the whole brain radiotherapy (WBRT) failure.Methods We retrospectively analyzed 35 patients with brain metastases from small-cell lung cancer treated with linear accelerator FSRT after the WBRT failure. Multivariate analysis was used to determine significant prognostic factor related to survival.ResultsThe following-up rate was 100％.The median following-up time was 11 months.The median over-all survival (OS) time was 10.3( 1 -30) months after FSRT.Controlled extra cranial disease was the only identified significant predictor of increased median OS time (χ2 =4.02,P =0.045 ).The median OS time from the diagnosis of brain metastasis was 22 (6 - 134 )months.14 patients died from brain metastasis,14 from extra-cranial progression,1 from leptomeningeal metastases,and 3 from other causes. Local control at 6 months and 12 months was 91％ and 76％,respectively.No significant late complications.New brain metastases outside of the treated area developed in 17％ of patients at a median time of 4(2 -20) months; all patients had received previous WBRT.ConclusionsFractionated stereotactic radiotherapy was safe and effective treatment for recurrent small-cell lung carcinoma brain metastases.

Application of parallel acquisition technique combined with echo-planar diffusion-weighted imaging technology in the diagnosis of liver micrometastasis for the patients with prooperation of colon cancer / 中国基层医药

Objective To discuss the role of EPI-DWI unite ASSET in the detection of hepatic colorectal micrometastasis. Methods 29 patients with hepatic colorectal metastasis were examined with EPI-DWI unite ASSET and EPI-DWI. Results In a lesion detection analysis,the overall detection rate was 93% (58/63) for ASSET-EPI-DWI,and 81% (51/63) for diffusion-weighted MR imaging. ASSET and EPI-DWI was more sensitive than diffusion-weighted MR imaging(P = 0.01 1). Conclusion ASSET-EPI-DWI is superior to diffusion-weighted MR imaging in the detection of hepatic colorectal micrometastasis.

Prospective study of bone metastasis from prostate cancer: comparison between large field diffusion-weighted imaging and bone scintigraphy / 中华放射学杂志

Objective To evaluate the large field diffusion weighted imaging (DWI) (from head vertex to lower leg) in detection of bone metastases from prostate cancer. Methods One hundred and sixty-six consecutive patients who were suspected of prostate cancer received pelvic MRI and large field diffusion weighted imaging examination. Forty-nine of them underwent bone scintigraphy within one month of the examination of large field DWI. The images were double-blindly evaluated without the knowledge of the pathology result. Conventional MR T1 and fat saturation T2 weighted images were taken as standard for the diagnosis of bone metastasis. The sensitivity, specificity, and area under curve between large field DWI and bone scintigraphy were compared with McNemar test. Five patients with bone metastases exceeding 10 per patient were excluded in the lesion-by-lesion analysis. Results Ten of the 49 patients were diagnosed as bone metastases. The diagnosis of bone metastasis were made in 15 patients by large field DWI and in 17 patients by bone scintigraphy. With patient number as study units (n =49) , the diagnostic sensitivity of bone metastases with large field DWI and bone metastases were both 100% (10/10), and specificity were 87. 2% (34/39) vs. 82. 1% (32/39), respectively. ROC study showed the area under curve (AUC) of large field DWI and bone scintigraphy were 0. 936 vs. 0. 910, respectively. Totally 68 abnormal foci were identified from large field DWI and/or bone scintigraphy in 44 patients (while 5 patients with bone metastases exceeding 10 foci per patient were excluded ), 20 of them were diagnosed as foci of bone metastasis. The diagnosis of bone metastases was made in 23 foci by large field DWI and in 34 by bone seintigraphy. With lesion numbers as study units ( n = 68), the diagnostic sensitivity of large field DWI and bone scintigraphy were both 90. 0% ( 18/20), and specificity were 89.6% (43/48) vs. 66. 7% (32/48) , respectively. ROC study showed the area under curve of large field DWI and bone scintigraphy were 0. 898 vs. 0. 783, respectively. The difference of specificity between large field DWI and bone scintigraphy showed statistical significant difference (P < 0. 01 ). The AUC between large field DWI and bone scintigraphy showed statistical significant difference (P < 0. 05). Conclusion Large field DWI may allow us to screen for bone metastasis in patients with prostate cancer, and its diagnostic specificity and accuracy may be higher than that of bone scintigraphy.

Studies on blood supply of liver metastasis with DSA,CT and portal vein perfusion CT during superior mesenteric arterial portography / 中华放射学杂志

Objective To probe the blood supply of liver metastasis by celiac artery,proper hepatic artery DSA.portal vein perfusion CT during superior mesenteric arterial poaography(PCTAP).Methods One hundred patients with liver metastases were examined prospectively by plain CT scan,multiphase enhanced CT scan,celiac arteriography and proper hepatic artefiography.Of them,56 patients were examined by PCTAP.All primary lesions wero confirmed by operation and(or)pathology examination.In order to investigate the blood supply of metastasis lesions.the software of Photoshop Was used to obtain the time-attenuation cugves(TDC)of tumor center,tumor edge,portal vein and normal liver parenchyma adjacent to the tumor to talculate liver perfusion for DSA image analysis,while a deconvolution model from CT perfusion software Was designed for the dual blood supply.Results DSA findings:TDC of proper hepatic arteriography showed:the mean peak concentration(K value)in tumor centers was(67±12)%,and it was(76±15)%for peritumor tissue,(51±10)%in normal liver parenchyma.TDC of celiac arteriogaphy showed that the contrast concentration of tumor centers and tumor edge increased fast in early stage.then maintained a slight upward plateau,in the meanwhile,the contrast concentration of normal liver parenchyma kept increasing slowly.PCTAP findings:tumors exhibited no enhancement during 30 s continued scans.Conciusion The blood supply of liver metastasis mainly comes from hepatic artery,but barely from portal vein.

Endovascular Treatment of Massive Retroperitoneal Hemorrhage Due to Spontaneous Rupture of Right Adrenal Gland Metastasis that was Secondary to Invasive Hepatocellular Carcinoma: A Case Report

The reported incidence of spontaneous rupture of primary hepatocellular carcinoma (HCC) is up to 14.5%. However, rupture of the metastatic lesions of HCC is very rare. We describe here a case of massive retroperitoneal hemorrhage due to spontaneous rupture of right adrenal gland metastasis that was secondary to invasive HCC. This was successfully controlled by performing transcatheter arterial embolization (TAE).

Thyroglobulin Measurement in the Fine-Needle Aspiration Washout for Diagnosing Cervical Lymph Node Metastasis in the Patients with Differentiated Papillary Thyroid Cancer

PURPOSE: We wanted to evaluate the utility of thyroglobulin measurement in the washout of the needle (FNA-Tg) used for fine needle biopsy for detecting lymph node metastasis in patients with differentiated papillary thyroid carcinoma (DPTC). MATERIALS AND METHODS: We performed ultrasonography-guided fine-needle aspiration cytology (FNAC) and FNA-Tg for 50 ultrasonographically suspicious lymph nodes in 45 DPTC patients. Eighteen patients underwent thyroidectomy before FNA and the remaining 27 patients underwent fine-needle aspiration prior to surgery. The final diagnoses were determined based on the results of histological examination of the excised specimens (n=21) or on the follow-up examination that was done least 12 months after surgery. RESULTS: Lymph node metastases were confirmed in 19 patients. FNAC detected 14 metastatic lymph nodes in 14 patients, and FNA-Tg detected 18 metastatic lymph nodes in 18 patients. While none of 3 cystic lymph nodes metastasis was detected via FNAC, they all revealed positive results via FNA-Tg. One patient with a negative result on both methods had one metastatic lymph node among 9 excised lymph nodes, and this one node had not been sampled via FNAC or FNA-Tg. The sensitivities and specificities of FNAC and FNA-Tg were 73.6% (14/19) and 100% (27/27), and 94.7% (18/19) and 96.2% (26/27), respectively. CONCLUSION: FNA-Tg is a useful technique for the early detection of lymph node metastasis, and especially for detecting cystic lymph node metastasis in patients with DPTC.

Detection of Pulmonary Metastatic Nodules: Usefulness of Low-dose Multidetector CT in Comparison with Chest Radiograph

PURPOSE: We wanted to evaluate the usefulness of low-dose multidetector CT for the detection and follow-up of pulmonary metastatic nodules in patients suffering with malignancy. MATERIALS AND METHODS: We retrospectively reviewed the conventional chest radiographs and low-dose multi-detector CT (low-dose CT) scans of 81 patients who had been under the diagnosis of malignancy. We reviewed the detection of pulmonary nodules and we counted the number of nodules detected by each method. The nodules were confirmed by surgical operation and by the radiologic criteria. The accuracy, sensitivity, specificity and positive and negative predictive values of each method for detecting metastatic nodules were compared with x2 tests. RESULTS: Low-dose CT depicted more nodules than did chest radiograph, and the indeterminate nodules seen on chest radiograph may be clearly benign on low-dose CT (eg. calcified granulomas or bony lesions). The accuracy of low-dose CT (75.3%) was significantly higher than that of chest radiograph (49.4%) for the detection for metastatic nodules (p <0.05). CONCLUSION: Low-dose CT may provide better information than does chest radiograph for diagnosing pulmonary metastasis.

Detection of Pulmonary Metastatic Nodules: Usefulness of Low-dose Multidetector CT in Comparison with Chest Radiograph

PURPOSE: We wanted to evaluate the usefulness of low-dose multidetector CT for the detection and follow-up of pulmonary metastatic nodules in patients suffering with malignancy. MATERIALS AND METHODS: We retrospectively reviewed the conventional chest radiographs and low-dose multi-detector CT (low-dose CT) scans of 81 patients who had been under the diagnosis of malignancy. We reviewed the detection of pulmonary nodules and we counted the number of nodules detected by each method. The nodules were confirmed by surgical operation and by the radiologic criteria. The accuracy, sensitivity, specificity and positive and negative predictive values of each method for detecting metastatic nodules were compared with x2 tests. RESULTS: Low-dose CT depicted more nodules than did chest radiograph, and the indeterminate nodules seen on chest radiograph may be clearly benign on low-dose CT (eg. calcified granulomas or bony lesions). The accuracy of low-dose CT (75.3%) was significantly higher than that of chest radiograph (49.4%) for the detection for metastatic nodules (p <0.05). CONCLUSION: Low-dose CT may provide better information than does chest radiograph for diagnosing pulmonary metastasis.

CT Findings of Locoregional Recurrence after Curative Resection of Colorectal Cancer

Postoperative recurrence is a major cause of mortality and morbidity for the patients suffering with colorectal cancer. Therefore, patients with colorectal cancer are routinely followed up with CT to detect the presence of locoregional recurrence and distant metastases. A central goal of postoperative surveillance for colorectal cancer is to improve survival through the earlier identification of tumor recurrence. Locoregional recurrence refers to tumor occurring at or adjacent to the surgical site and at the regional lymph nodes. It has been reported that metastatic spread based on the site of the primary tumor shows a relatively predictable pattern. Given the prevalence of colorectal cancer and the role of CT for postoperative surveillance, radiologists should be familiar with the CT findings of locoregional recurrence after curative resection for colorectal cancer.

Hepatic Metastasis of Thymoma: A Case Report

Thymoma is the most common neoplasm in the anterior mediastinum, and extrathoracic involvement is rare. Moreover, cystic liver metastasis is extremely rare; few cases have been reported in the literature to date. We report here on a case of cystic liver metastasis of thymoma treated with surgical resection, describing the ultrasonography, CT and MRI findings.

Pineal Germinoma with Extracranial Metastases: Case Report

Pineal germinoma is the commonest pineal region tumor of childhood and adolescence. Metastatic germinoma most commonly occurs via the cerebrospinal fluid (CSF), and it is usually limited to the cerebrospinal axis. Extacranial hematogenous metastasis is known to be very rare. We report here on a case of pineal germinoma with gradual extracranial metastases that occurred both through the CSF pathway and by hematogenous spread. The patient had multifocal CSF seeding after his surgery for pineal germinoma, and the left iliac metastasis and lung metastasis then occurred.

Cystic Changes in Intraabdominal Extrahepatic Metastases from Gastrointestinal Stromal Tumors Treated with Imatinib

OBJECTIVE: This study was undertaken for the purpose of describing the CT features of intra-abdominal extra-hepatic metastases from gastrointestinal stromal tumors in patients who were treated with imatinib. MATERIALS AND METHODS: Eleven patients with intra-abdominal extra-hepatic metastases from gastrointestinal stromal tumors, who were treated with imatinib between May 2001 and December 2003, were included in this study. The clinical findings and CT scans were retrospectively reviewed. The metastatic lesions were assessed according to the location, size (greatest diameter), attenuation, and the enhancing pattern before and after imatinib treatment. RESULTS: Prior to the treatment, the sizes and attenuation values of the metastatic lesions ranged from 5 to 20 cm and from 63 to 131 H, respectively. The metastatic lesions showed a heterogeneous enhancement pattern on the contrast-enhanced CT scans. After the treatment, the metastatic lesions became smaller in all 11 patients, and the corresponding attenuation value ranged from 15 to 51 H. The metastatic lesions became homogeneous and cystic in appearance on the follow-up CT scans, mimicking ascites. CONCLUSION: Intra-abdominal extra-hepatic metastases of patients with gastrointestinal stromal tumors treated with imatinib may appear as well-circumscribed cystic lesions on contrast-enhanced CT. These metastases are likely to become smaller and resemble ascites, but may persist indefinitely on the follow-up CT.

Follow-up Results After Negative Findings on Unenhanced Hepatic MR Imaging for Hepatic Metastasis from Rectal Cancer

OBJECTIVE: To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery. MATERIALS AND METHODS: From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image. RESULTS: During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%. CONCLUSION: Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.

Comparison of High-resolution CT Findings between Miliary Metastases and Miliary Tuberculosis

PURPOSE: To compare the findings of high-resolution computed tomography (HRCT) between patients with miliary metastases and miliary tuberculosis. MATERIALS AND METHODS: Between May 1998 and April 2002, 11 patients with miliary metastases and 18 with miliary tuberculosis underwent HRCT, and we reviewed the findings. In miliary metastases, the primary lesions were adenocarcinoma of the lung (n=2), stomach (n=1), or pancreas (n=1), or of unknown origin (n=5), and papillary carcinoma of the thyroid (n=2). Two radiologists blinded to the clinical and pathologic data reached a consensus regarding nodule size and margin, their distribution and coalescence, interstitial involvement, and other ancillary HRCT findings. Data were analyzed using the chi-square test. RESULTS: CT scans showed numerous 1 to 5-mm nodules randomly distributed throughout both lungs of all patients. Nodules larger than 1.5 mm in diameter were more often seen in miliary metastases (81.9%). In six (54.5%) patients with miliary metastases and in three (16.7%) with miliary tuberculosis, nodule size varied (p<0.05). Pleural effusion occurred in three (27.3%) patients with miliary metastases and three (16.7%) with miliary tuberculosis. Interlobular septal thickening (100%) and peribronchovascular thickening (63.6%) were more common in miliary metastases than in miliary tuberculosis (p<0.01). Lymph node enlargement was seen in 11 (100%) patients with miliary metastases and five (27.8%) with miliary tuberculosis (p<0.001). CONCLUSION: At HRCT, lymph node enlargement and both interlobular and peribronchovascular thickening are more commonly observed in miliary metastases than in miliary tuberculosis.

Ground-Glass Opacity in Lung Metastasis from Adenocarcinoma of the Stomach: A Case Report

Ground-glass opacity is a frequent but nonspecific finding seen on high-resolution CT scans of lung parenchyma. Histologically, this appearance is observed when thickening of the alveolar wall and septal interstitium is minimal or the alveolar lumen is partially filled with fluid, macrophage, neutrophils, or amorphous material. It has been shown that ground-glass opacity may be caused not only by an active inflammatory process but also by fibrotic processes. When a focal area of ground-glass opacity persists or increases in size, the possibility of neoplasm-bronchioloalveolar carcinoma or adenoma, or lymphoma, for example- should be considered. Diffuse nonsegmental ground-glass opacity in both lung fields was incidentally found on follow up abdominal CT in a stomach cancer patient and signet-ring cell-type metastatic lung cancer was confirmed by transbronchial lung biopsy. We report a case of diffuse ground-glass opacity seen in metastatic lung cancer from adenocarcinoma of the stomach.