LUNG METASTASIS

LUNG METASTASIS
Lung is a common site for metastasis from malignancies from other organs.
  • Lung is a capillary bed and the entire cardiac output passes through it, thus it is no surprise tumors get trapped in lungs.
  • Various patterns of metastasis should be recognized. Common patterns are
    • Solitary
    • Cannon balls
    • Lymphangitic
    • Pleural effusions
Clinical Presentation
Mode of clinical presentation varies depending on the pattern of metastasis.
  • Asymptomatic, detected on routine CXR.
  • Cough, hemoptysis, pneumonia, wheezing with endobronchial mets.
  • Shortness of breath, cough with lymphatic spread.
  • Pleuritic pain, cough and shortness of breath with pleural effusions.
Diagnosis
Again depends on the metastatic pattern.
  • FNAB for solitary or multiple lung mets.
  • Sputum cytology and bronchoscopy for endobronchial mets.
  • Pleural fluid cytology for effusions.
  • Tranbronchial lung biopsy for lymphatic spread.
Treatment
Very important treatment issues revolve around the presence and pattern of metastasis.
  • Lung metastasis most often would preclude a surgical curative resection of the primary.
  • Surgical resection of a solitary lung metastasis along with resection of the primary can accomplish cure in certain tumors.
  • Brachytherapy therapy may be useful to relieve symptoms with endobronchial mets.
  • Pleural sclerosis is necessary in pleural effusions.
  • Certain chemotherapeutic agents can sequester in effusions.



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