Progress in surgical treatment of pulmonary metastases / 中国胸心血管外科临床杂志

@#Lung is one of the most common metastatic organs of carcinomas. Pulmonary metastasectomy has become a common procedure in thoracic surgery and its effectiveness has been demonstrated by many researches. Once the malignant tumor is combined with lung metastasis, which belongs to the category of advanced tumor, surgical resection is only a palliative treatment to reduce the tumor load. However, there are still some controversies among the surgical indications, preoperative examinations, surgical methods and resection ranges, lymph node management, recurrence and re-resection of metastatic tumor and prognostic factors. This article reviews pulmonary metastasectomy from the above aspects.

Bilateral renal metastases from papillary thyroid carcinoma: a case report / 中华泌尿外科杂志

Papillary thyroid carcinoma metastasizing to the kidney are extremely rare events, which may easily be misdiagnosed as renal cell carcinoma. The diagnosis needs to be based on immunohistochemical examination. We described a case of renal tumor to be proved renal metastatic carcinoma from thyroid origin by pathological examination. Computed tomography (CT) scan shows metastasis nodules in lungs. Following total thyroidectomy, he underwent iodine-131 ( 131Ⅰ), thyroid hormone and sorafenib to treat thyroid remnant tumor and metastases. Partial nephrectomy was conducted to remove the left renal metastatic carcinoma for preserving normal renal function. Follow-up revealed that partial pulmonary nodule gradually shrunk, and no new metastasis appeared.

Progress in Surgery for Pulmonary Metastases / 中国肺癌杂志

Lung is the most common metastatic site for tumors other than the liver. Pulmonary metastasectomy is also one of the common operations in thoracic surgery. However, the effect of pulmonary metastasectomy is controversial. As far as the current experience is concerned, patients with pulmonary metastases with long disease free interval, low-grade malignant tumor and complete excision have the greatest benefit from metastasectomy. This review is about the progress of surgical treatment of pulmonary metastases.
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Surgical resection for pulmonary metastases from head and neck squamous cell carcinoma: Current status and perspectives / 肿瘤

Lung is the most common metastatic site of head and neck squamous-cell carcinoma (HNSCC). Systemic chemotherapy is still the standard treatment for metastatic HNSCC patients, and the prognosis is poor. Pulmonary metastasectomy has been regarded as the stardard treatment modality for selected pulmonary metastases from certain cancers including colorectal cancer and sarcoma. However, present studies about pulmonary metastasectomy for metastatic HNSCC are retrospective and no consensus has been reached on the value of pulmonary metastasectomy. This review focuses on the efficiency, indication, operative mode and method and the prognostic factors of pulmonary metastasectomy for pulmonary metastases from HNSCC. The limitations of current studies and the challenges and perspectives of pulmonary metastasectomy are also discussed.

Analysis of risk factors of pulmonary metastasis and prognosis of patients after anterior resection of rectal cancer / 中华消化外科杂志

Objective To investigate the risk factors of pulmonary metastasis and prognosis of patients with rectal cancer after anterior resection of rectal cancer.Methods The retrospective case-control study was adopted.The clinical data of 421 patients with rectal cancer who underwent anterior resection at the First Hospital of China Medical University from August 2010 to December 2014 were collected.The patients were followed up by outpatient examination and telephone interview once three months in the first postoperative year,once half a year in the second postoperative year,and then once a year.The follow-up included satuses of pulmonary metastasis and survival of patients after anterior resection of rectal cancer.The end point of follow-up was death of the patients or 31 December,2014.The risk factors of pulmonary metastasis and prognosis in patients after anterior resection of rectal cancer were analyzed.Measurement data with normal distribution were presented as x-± s and measurement data with skewed distribution were presented as M(range).The pulmonary metastasis rate/curve and survival rate/curve were calculated and drawn by the Kaplan-Meier method.The comparisons of pulmonary metastasis rate and survival rate were done using the Log-rank test.The univariate analysis was done using the chi-square test and Log-rank test.The multivariate analysis was done by Logistic regression model and COX regression model.Results Of the 421patients,389 patients were successfully followed up with a median time of 34 months (range,11-53 months) and a follow-up rate of 92.40％ (389/421).Ninety-four,168 and 127 patients were detected in Ⅰ,Ⅱ and Ⅲ stages of TNM stage.There were 29 patients diagnosed with postoperative pulmonary metastasis with the diagnosis time of (21 ± 9) months.The 3-year cumulative incidence of pulmonary metastasis after anterior resection of rectal cancer was 2.2％ in patients of Ⅰ stage,3.0％ in patients of Ⅱ stage and 17.4％ in patients of Ⅲ stage,showing significantly increase trend as the increase of the TNM stage (x2=19.927,P ＜ 0.05).The 29 patients with pulmonary metastasis did not receive chemoradiotherapy including 6 patients receiving pulmonary metastatic nodule recection.Nineteen patients were survived and 10 patients were dead.The survival time of patients diagnosed with pulmonary metastasis was (13 ±9)months and the 3-year cumulative survival rate was 75.7％,whereas the survival time of patients without postoperative pulmonary metastasis was (35 ±9)months and the 3-year cumulative survival rate was 94.3％,showing significant difference between the 2 kinds of patients (x2 =25.219,P ＜ 0.05).The univariate analysis showed that the preoperative carcinoembryonic antigen (CEA) level,degree of tumor differentiation,depth of invasion and lymph node metastasis were risk factors affecting pulmonary metastasis after anterior resection of rectal cancer (x2=4.745,7.250,5.379,18.796,P ＜ 0.05),and the multivariate analysis showed that lymph node metastasis was an independent risk factor affecting postoperative pulmonary metastasis [OR =4.167,95％ confidence interval (CI):1.608-10.801,P ＜ 0.05].The univariate analysis showed that the preoperative CEA level,distribution and number of pulmonary metastatic nodule and lymph node metastasis were risk factors affecting the prognosis of patients with pulmonary metastasis after anterior resection of rectal cancer (x2=13.793,7.246,6.284,4.076,P ＜ 0.05),and the multivariate analysis showed that the preoperative CEA level ＞ 5 μg/L was an independent risk factor affecting the prognosis of patients (HR =13.489,95 ％ CI:1.407-129.297,P ＜ 0.05).Conclusions Pulmonary metastasis after anterior resection of rectal cancer is common.Lymph node metastasis is a high risk factor affecting postoperative pulmonary metastasis,and preoperative CEA level ＞ 5 μg/L is an independent risk factor affecting the prognosis of patients with postoperative pulmonary metastasis.

High-Dose Vitamin C Promotes Regression of Multiple Pulmonary Metastases Originating from Hepatocellular Carcinoma

We report a case of regression of multiple pulmonary metastases, which originated from hepatocellular carcinoma after treatment with intravenous administration of high-dose vitamin C. A 74-year-old woman presented to the clinic for her cancer-related symptoms such as general weakness and anorexia. After undergoing initial transarterial chemoembolization (TACE), local recurrence with multiple pulmonary metastases was found. She refused further conventional therapy, including sorafenib tosylate (Nexavar). She did receive high doses of vitamin C (70 g), which were administered into a peripheral vein twice a week for 10 months, and multiple pulmonary metastases were observed to have completely regressed. She then underwent subsequent TACE, resulting in remission of her primary hepatocellular carcinoma.

Prostate Cancer in a Patient with Multiple Pulmonary Metastases Alone andRespiratory Symptoms / Journal of Rural Medicine

An 87-year-old man was admitted complaining of cough after he had been treated with drugsat another hospital. Chest X-ray revealed multiple nodules, and chest computed tomography(CT) showed metastatic lung tumors. Abdominal CT revealed staining of the outer portion ofthe prostate by contrast medium, though this finding was considered nonspecific andnondiagnostic. A CT-guided biopsy of a lung tumor was performed, and the lung tumor wasfound to be positive for prostate-specific antigen (PSA). Prostate carcinoma was diagnosedby prostate biopsy, which yielded the same findings as the lung tumor. The serum PSA levelwas high. No metastases except for pulmonary lesions were observed on a bone scintigramand abdominal CT. Prostate carcinoma with pulmonary metastases alone was thereforediagnosed. The present case represents a rare case of pulmonary metastases without anyother metastases.

Prognostic factors related to simple lung metastases in 90 patients with primary colorectal cancer / 肿瘤

Objective: To investigate the prognostic factors related to overall survival and prognosis of patients with simple lung metastases from primary colorectal cancer. Methods: The clinical data from 90 patients with simple lung metastases from primary colorectal cancer were retrospectively reviewed. Of these 90 patients, 34 received R0 resection of lung metastases, and 56 received systemic chemotherapy. The survival analysis was performed by Kaplan-Meier method. The log-rank test was used for univariate analysis and the COX proportional hazards model for multivariate analysis of prognosis. Results: The 1-, 2- and 3-year cumulative survival rates between the patients receiving R0 resection of lung metastases and systemic chemotherapy were significantly different (97.1% vs 82.1%, P < 0.05; 88.2% vs 55.3%, P < 0.05; 74.9% vs 31.4%, P < 0.05). The 1-, 2- and 3-year disease-free survival rates of patients receiving R0 resection of lung metastases were 64.7%, 43.9% and 33.8%, respectively. The univariate analysis revealed that in patients receiving R0 resection of lung metastases, the factors of hilar or mediastinal lymph node metastases (P = 0.003), the maximum tumor size of pulmonary metastases (P = 0.007) and preoperative serum carcinoembryonic antigen level (P = 0.029) were significantly correlated with the 3-year overall survival, and the factors of lymph node metastases after curative resection of colorectal cancer (P = 0.005), the maximum diameter of pulmonary metastases more than or equal to 4 cm (P = 0.006) and preoperative serum carcinoembryonic antigen level more than or equal to 5 ng/mL (P = 0.010) were significantly correlated with the recurrence after R0 resection of lung metastases, while in patients receiving systemic chemotherapy, the factor of use of all three cytotoxic agents including fluorouracil, oxaliplatin and irinotecan (P = 0.004) was significantly correlated with the 3-year overall survival. The mulitivariate analysis revealed that in patients receiving R0 resection of lung metastases, the factor of maximum diameter of pulmonary metastases more than or equal to 4 cm (P = 0.032) was an independent prognostic factor related to the 3-year overall survival, while the factors of positive lymph node metastases after curative resection of the primary colorectal cancer (P = 0.030) and the maximum diameter of pulmonary metastases more than or equal to 4 cm (P = 0.049) were independent prognostic factors related to the recurrence after R0 resection of lung metastases. Conclusion: The overall survival of patients receiving R0 resection of lung metastases from primary colorectal cancer especially for the patients with the maximum diameter of pulmonary metastases less than 4 cm can be significantly improved. The overall survival of patients receiving systemic chemotherapy using all three cytotoxic agents including fluorouracil, oxaliplatin and irinotecan can also be significantly prolonged. Copyright © 2013 by TUMOR.

Prostate Cancer in a Patient with Multiple Pulmonary Metastases Alone and Respiratory Symptoms / Journal of Rural Medicine

An 87-year-old man was admitted complaining of cough after he had been treated with drugs at another hospital. Chest X-ray revealed multiple nodules, and chest computed tomography (CT) showed metastatic lung tumors. Abdominal CT revealed staining of the outer portion of the prostate by contrast medium, though this finding was considered nonspecific and nondiagnostic. A CT-guided biopsy of a lung tumor was performed, and the lung tumor was found to be positive for prostate-specific antigen (PSA). Prostate carcinoma was diagnosed by prostate biopsy, which yielded the same findings as the lung tumor. The serum PSA level was high. No metastases except for pulmonary lesions were observed on a bone scintigram and abdominal CT. Prostate carcinoma with pulmonary metastases alone was therefore diagnosed. The present case represents a rare case of pulmonary metastases without any other metastases.

The clinical therapeutic effects of arsenic trioxide combined with transcatheter arterial chemoembolization in treating primary liver cancer with pulmonary metastases / 中华内科杂志

Objective To observe the therapeutic effects of arsenic trioxide combined with transcatheter arterial chemoembolization on treatment of primary liver cancer with pulmonary metastases.Methods Sixty patients were randomly divided into two groups:group A (treatment group,n =30) and group B (control group,n =30).Group A was received periodic transcatheter arterial chemoembolization (TACE) and 10 mg arsenic trioxide by intravenous infusion for 5 hours per day,3 days after TACE.Each cycle consisted of 14 days' administration,and repeated after 2 weeks.Each patient was received 3-4 successive cycles.Group B was received periodic TACE alone.Objective efficiency,benefit rate,quality of life and the correlates with metastatic tumor size and number in the both groups were recorded.Results The objective efficiency was 26.7％ (8/30),and the benefit rate was 60.0％ (18/30) in group A,while they were 0 and 16.7％ (5/30) in group B with significant statistics differences (x2 =7.067,P =0.008;x2 =11.915,P =0.001).The quality of life was improved in 4 patients and stable in 18 of group A,while no patient was improved and 13 were stable in group B (x2 =9.669,P =0.008).There was a significantly positive correlation between the tumor burden and therapeutic effect (Kendall r =-0.765,P ＜ 0.001 ;Spearman r =-0.821,P ＜ 0.001).Conclusion Arsenic trioxide combined TACE is an effective treatment method in treating primary liver cancer with pulmonary metastases.

Aggressive Angiomyxoma: an Unusual Presentation

Aggressive angiomyxoma is an uncommon mesenchymal myxoid tumor that is characterized by slow growth and frequent local recurrence. It is currently regarded as a nonmetastasizing tumor. We describe a case of recurrent aggressive angiomyxoma with invasion into the veins including the inferior vena cava and the right atrium and with pulmonary metastases. Our case, together with those unusual cases documented in previous reports, may lead to a reappraisal of the nature of aggressive angiomyxoma.

Diagnostic Usefulness of Routinely Performed Preoperative Chest Computed Tomography for Colorectal Cancer

PURPOSE: The most common site of metastases in colorectal cancer (CRC) is the liver, and the second common site is the lung (10-20%). Preoperative staging for CRC is very important. The aim of this study was to assess the usefulness of chest computed tomography (CT) for preoperative staging in CRC. METHODS: From January 2006 to December 2007, a total of 597 patients with colorectal cancer underwent surgery at our hospital. One hundred fifty of those patients had received chest CT preoperatively. We analyzed the chest radiologic findings from chest x-ray (CXR), abdominal CT, and chest CT. RESULTS: The detection rate of abnormal lung findings was higher in chest CT than in the other chest radiologic findings (chest PA: 10 [6.6%]; abdominal CT: 19 [12.7%]; chest CT: 48 [32.0%]). On the chest CT, 19 of the 150 (12.7%) patients that had received a chest CT preoperatively were initially suspected of having malignant lesions. Besides two primary lung malignancies (solitary nodules), metastatic lesions were revealed in 5 (3.3%), 11 (7.3%), and 17 (11.3%) patients on CXR, abdominal CT, and chest CT, respectively. Eleven (64.7%) of the patients having metastatic chest CT lesions were also identified on lower lung fields by abdominal CT. Seven also had other metastatic foci (liver and paraaortic LN). Initially, stage IV was identified in 37 (24.7%) and 40 (26.7%) patients in abdominal CT and chest CT, respectively. After one year, 11 of the 150 (7.3%) patients who had received a chest CT had been diagnosed with pulmonary metastasis. CONCLUSION: Chest computed tomography is the most sensitive method for the diagnosis of pulmonary metastases. However, if the interpretations of abdominal CT and individualized diagnostic methods are accurate, the demand for unnecessary preoperative work-up may be reduced.

A systematic review of the effect of radioiodine.131 in treatment of pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors / 中华内分泌代谢杂志

Objective To assess the effect of radioiodine-131 (131Ⅰ) on treatment of pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors. Methods Five databases were retrieved and all published studies which analyzed the effect of 131Ⅰ on pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors were systematically reviewed. The data about the impact of 131Ⅰ treatment and the main prognostic factors on the 5-yr and 10-yr survival rates of the patients were abstracted. RevMan 4.2 software was used to statistically analyze. Results Eleven retrospective cohort studies were included. The pooled results suggested that the 5-yr survival rates of the patients who received 131Ⅰ therapy and who did not received 131Ⅰl therapy were 74.9% and 27.1% , respectively ;The lO-yr survival rates(P<0.01)of the two groups were 60.8% % 12.2% , respectively;The difference between them had statistical significance (P<0.01). The 5-yr and 10-yr survival rates of the patients only with pulmonary metastases were higher than those of the patients with multiple metastases (P<0.01). The 5-yr (P = 0.01) and 10-yr (P = 0. 002)surviv10al rates of the patients only with papillary thyroid carcinoma were higher than those of the patients with follicular thyroid carcinoma. The 5-yr and 10-yr survival rates of male and female patients were similar(P>0.05). Conclusions 131Ⅰ treatment increases the 5-yr and 10-yr survival rates of patients with pulmonary metastases from differentiated thyroid carcinoma. The extent of metastases and the histologie type of differentiated thyroid carcinoma are two main predicting factors of prognosis. The 5-yr and 10-yr survival rates of patients are not influenced by gender.

Atypical Pulmonary Metastases from a True Malignant Mixed Tumor of the Parotid Gland

A 58-year-old male patient presented with a recurrent true malignant mixed tumor of the parotid gland. Patchy pulmonary opacities were identified with a chest radiograph. Subsequently, a CT scan of the chest showed pulmonary parenchymal consolidation with amorphous calcifications. This abnormality was confirmed to be the result of a metastatic true malignant mixed tumor by using CT-guided biopsy. The current case demonstrated an extremely rare example of atypical pulmonary metastases from a true malignant mixed tumor of the parotid gland showing an air-space pattern and calcification.

Lung Metastasis of Colorectal Cancer

PURPOSE: The lung is the second most common site of metastasis of colorectal cancer. Pulmonary resection of lung metastasis of colorectal cancer has been reported a 5-year survival rate of 9~57% variably. Therefore we have tried to assess the clinical patterns of lung metastasis from colorectal cancer and to evaluate prognostic factors. METHODS: A retrospective study was performed on 76 patients who presented with colorectal cancer with pulmonary metastasis between Jan. 1993 and Dec. 2001. Follow up period was 2~92 months. RESULTS: 53 patients had developed pulmonary metastasis after curative resection of colorectal cancer, 27 patients of these cases showed isolated lung metastasis and 12 patients underwent pulmonary resection. The number of patients with single pulmonary nodule was 7 and they showed higher survival rate than those of multiple nodules (2-year survival rate: 80% vs. 33.3%, P=0.0325). The patients with normal serum CEA level showed higher survival rate than those with elevated serum CEA level (median survival-71 months vs. 32 months, P=0.0123) in 53 patients who had developed pulmonary metastasis after curative resection of primary tumor. The number of patients of TNM stage IV with synchronous lung metastasis was 23. And serum CEA level and the number of metastatic site had affected the survival in these cases. CONCLUSIONS: The serum CEA level could be prognostic factors in pulmonary metastasis of colorectal cancer. And pulmonary resection for selected patients may improve the survival rate especially in the case which the number of metastatic nodule was only one.

Metástasis pulmonar miliar como primera manifestación de carcinoma de tiroides bien diferenciado en niños

Objetivo: Presentar el caso de una adolescente con manifestaciones de afectación pulmonar como motivo de consulta, debido a una metástasis pulmonar miliar de carcinoma (Ca) papilar de tiroides. Caso Clínico: Se trata de una adolescente femenina de 13 años de edad quien presenta tos seca, disnea de esfuerzo, palpitaciones, dolor precordial, y pérdida de peso de 15 días de evolución. Al examen clínico se evidencia aumento de volumen de la región anterior del cuello a predominio izquierdo, con adenopatía cervical palpable, acrocianosis y cianosis peribucal. Hematología completa, función tiroidea y electrocardiograma normales. La gasometría arterial demuestra una hipoxemia severa. En Rx. de tórax se observa infiltrado miliar micro y macronodular bilateral. En ultrasonido impresionan adenopatías de ubicación pretraqueal y paracarotideas. Tomografía de cuello revela imagen altamente sugestiva de malignidad en lóbulo tiroideo izquierdo y tomografía toraco-abdominal muestra infiltrado pulmonar bilateral micronodular sugestivo de lesiones metastásicas. Estudio histopatológico de ganglio latero cervical izquierdo reporta metástasis de Ca papilar tiroideo a predominio de estructuras foliculares. Se hace diagnóstico de carcinoma papilar bien diferenciado de tiroides con metástasis a región pulmonar, se realiza tiroidectomía total y control de T4L y TSH a los 30 y 60 días post cirugía, con valores normales de T4L y ligeramente aumentados de TSH (7 uU/ml), planteándose metástasis pulmonares funcionantes. Se indica terapia ablativa con I131 presentando evolución clínica estable, pero con cifras de 300 mg/dL de tiroglobulina a los seis meses, por lo que se planifica otra sesión con radioyodo. A propósito de este caso, el segundo en cinco años en la Unidad de Endocrinología del IAHULA, se lleva a cabo una revisión de la literatura sobre esta entidad nosológica. Conclusiones: En niños, el Ca papilar de tiroides puede ponerse en evidencia por las manifestaciones clínicas debidas a la afectación pulmonar, con un pronóstico reservado, sobre todo si se trata de metástasis pulmonares de tipo miliar.

Objective: To present the case of a female adolescent admitted with findings of pulmonary illness due to miliar pulmonary metastases of thyroid cancer. Clinical Case: A girl of 13 years old with non productive cough, dyspnea, palpitations, precordial pain and decrease of weigh, since fifteen days before she consulted at the pediatric emergency. She presented with a goiter, predominantly growing of the left lobe, with a cervical adenopathy, acrocyanosis and cyanosis of her lips. Complete haematology, thyroid function and electrocardiogram were normal. The arterial gasometry showed severe hypoxia. Chest radiography showed diffuse micro and macronodular lesions. Neck ecography showed definitive regional adenopaties. Neck tomography demonstrated an image suggestive of malignancy in left thyroid lobe and the thoracic tomography showed micronodular bilateral lesions, suggestive of me- tastases. Biopsy of the cervical left adenopathy concluded in metastases of papillary thyroid cancer with follicular structures. Total thyroidectomy was performed. Levels of TSH 60 days after surgery, were slightly increased (7 uU/ml), suggesting functioning pulmonary metastases. Ablative therapy with 131I was administrated, but 6 months after it, thyroglobulin levels were elevated (300 mg/dl) and the patient is waiting for another 131I therapy session. This is the second case studied in the Endocrinology Unit at the IAHULA. Conclusions: The clinical findings of pulmonary affectation could be the first manifestations of papillary thyroid cancer in children, specially if miliar pulmonary metastases are present, worsening the prognosis.

Is Routine Chest X-ray Useful in Detection of Pulmonary Metastases after Curative Resection for Colorectal Carcinoma?

PURPOSE: This study was performed to evaluate the effectiveness of conventional chest radiography and abdominal CT for early detection of pulmonary metastases after curative surgery for colorectal cancer. METHODS: We retrospectively reviewed 138 cases of pulmonary metastases from a group of colorectal-cancer patients, who were recruited from 1994 to 2002 at Samsung Medical Center, Sungkyunkwan University School of Medicine, and who had been surgically treated with a curative resection. RESULTS: The detection rates for pulmonary metastases were 34.1% by conventional chest radiography, 50.0% by abdominal CT, and 15.9% by other means. For stage I and II tumors, conventional chest radiography was superior to abdominal CT (45.7% vs. 34.3%, P<0.05) for detecting pulmonary metastases. On the contrary, for stage III tumors, abdominal CT was superior to conventional chest radiography (55.3% vs. 30.1%, P<0.05). Compared with stage I and II, pulmonary metastases in stage III had a tendency to be more numerous, bilateral, and extra-pulmonary. They also had a low detection rate by conventional chest radiography and a higher detection rate by abdominal CT, and they were associated with poor survival. CONCLUSIONS: Conventional chest radiography is no more useful in detecting early pulmonary metastases after curative colorectal surgery than abdominal CT, especially for stage III tumors. We propose the use of routine chest CT or extended abdominal CT for screening of occult lung metastases in stage III colorectal cancer patients.

Spinal Malignant Schwannoma with Hematogenous Pulmonary Metastases: Case Report

We report a case of multiple hematogenous pulmonary metastases from a spinal malignant schwannoma. A 54-year-old woman with a known primary spinal malignant schwannoma presented with a 2-month history of painful neck mass, ptosis, anhidrosis, facial edema and mild chest discomfort. She had had the spinal surgeries two times followed by postoperative radiation therapy. The chest radiograph revealed typical multiple metastatic nodules on the both lung fields. Metastatic malignant schwannoma to the lung was confirmed by fine needle aspiration biopsy using a 22-gauge needle under fluoroscopic gauidance. The result of cytology of the lung mass was malignant spindle cell tumors consistent with malignant schwannoma located in cervical spine. The course of metastases might be hematogenous due to direct vascular invasion of tumor.

A Case of Cavitary Pulmonary Metastases of Primary Cavitary Lung Cancer / 결핵

Many disorders and abnormalities are accompanied by cavitary lesoin of the lung and one of the most common causes of cavitary lung disease are primary and metastatic lung neoplasms. but cavitary formation of primary lung cancer is not frequent and cavitary or cystic pulmonary metastases of this is also rare. We report a case of cavitary pulmonry metastases of primary lung cancer proven by bronchoscopic biopsy and chest CT. The patients was 60 year-old heavy smoker who had never been underlying lung diseases 7 years ago and complained chronic cough. The chest CT showed primary lung cancer in right low lobe with multiple cavitary or cystic metastases in both lungs and multiple lymphatic metastases.

Surgery for Lung Metastases from Colorectal Cancer

PURPOSE: The liver and lung are the most common site of metastases after curative resection of colorectal carcinoma, and only 10 months of median survival is achieved once metastases has occurred in the lung. About 10% of patients have a solitary pulmonary metastasis and surgical resection leads to a 5 year survival rate of 21~43%. We have tried to define ideal candidates for pulmonary resection in a patient with pulmonary metastases from colorectal carcinoma. METHODS: Between March 1990 to Feb. 2001, 25 patients underwent pulmonary resection for metastatic colorectal carcinoma. 15 patients were male, and 10 were female with mean age of 60.0 (range, 36~73) years. The primary sites were colon in 7 patients and rectum in 18 patients. RESULTS: The mean disease free interval was 30.04 19.79 (range, 1~84) months and 19 patients had single metastasis and 6 patients had multiple metastatic lesions. Twenty- one patients had unilateral lesion. Wedge resection was done in 10 patients, lobectomy in 7, pneumonectomy in 2, wedge resection with bilobectomy in 2, segmentectomy and wedge resection in 1, and segmentectomy and lobectomy in 1 patient. Six patients recurred mean 13.7 months after the first operation (range, 1~33 months) and they underwent wedge resection in 4 and one case each of lobectomy and segmentectomy. Seven patients died during follow up with 3 year survival rate of 70.8% and 5 year survival rate of 43.4%. CONCLUSIONS: The disease free interval, number of metastases, type and location of pulmonary resection, level of carcinoembryonic antigen had no correlation with the survival rate. We conclude that surgical resection of colorectal lung metastases is safe and effective, and every patients should be evaluated as a surgical candidate.