A Case of Occult Lung Cancer Detected Seven Years After the Appearance of Brain Metastases

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  • Nakashima Yasuhiro
    Department of Thoracic Surgery, Musashino Red Cross Hospital Department of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research Department of Thoracic Surgery, Tokyo Medical and Dental University
  • Komatsu Yuu
    Department of Respiratory Medicine, Musashino Red Cross Hospital
  • Taki Reiko
    Department of Respiratory Medicine, Musashino Red Cross Hospital
  • Sakurai Urara
    Department of Pathology, Musashino Red Cross Hospital
  • Ishikawa Yuichi
    Department of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research
  • Kojima Katsuo
    Department of Thoracic Surgery, Musashino Red Cross Hospital

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Other Title
  • 脳転移巣の出現から7年後に顕在化した潜在性肺癌の1例

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Abstract

<p>Background. Primary lung cancer may present as cancer of unknown primary more often than other cancers, but rarely does the occult period of lung cancer reach seven years. We herein report a rare case of primary lung cancer that had been latent from the time when the patient was diagnosed with a metastatic brain tumor. Case. A 60-year-old male was referred to our hospital in 2008 for paralysis symptoms. On an examination, multiple brain tumors were incidentally detected, and craniotomy was performed. The brain tumor was a poorly differentiated adenocarcinoma and was thought to be a metastatic lesion. A whole-body examination, including 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT), failed to detect the primary tumor, and the case was followed up as cancer of unknown primary. In 2015, a tumor measuring 54×30 mm was detected inside the bulla of the left upper lobe, with PET/CT revealing the high accumulation of 18F-FDG. Left upper lobectomy and partial resection of S6+ND2a-1 were performed. The histological diagnosis was pleomorphic carcinoma (T3N0M1b [BRA], pStage IV); the tumor mainly comprised malignant spindle cells with a papillary adenocarcinoma component. The adenocarcinoma component and brain lesion showed histological and immunohistochemical similarities, including immunoreactivity for TTF-1 and Napsin A. Therefore, it was inferred that the cancer in the brain was metastasis of lung cancer that had been occult cancer for seven years. Conclusion. Given that even modern, advanced imaging technologies have some limitations, careful follow-up should be a requirement in cases of cancer of unknown primary.</p>

Journal

  • Haigan

    Haigan 57 (7), 838-842, 2017

    The Japan Lung Cancer Society

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