Pancreatic Cancer with Lung Metastasis Presenting with Chest Infiltrates

Clinical Image

Austin J Pulm Respir Med 2015;2(1): 1021.

Pancreatic Cancer with Lung Metastasis Presenting with Chest Infiltrates

Kushima H1*, Ishii H2, Umeki K1, Jo K1, Takeno Y1, Ando M1, Tokimatsu I1,3 and Kadota J1

1Department of Respiratory Medicine, Oita University Hospital, Japan

2Department of Respiratory Medicine, Fukuoka University Hospital, Japan

3Department of Infection Control and Prevention, Kobe University Hospital, Japan

*Corresponding author: Kushima H, Department of Respiratory Medicine, Oita University Hospital, 1-1 Idaigaoka, Yufu-city, Oita, 879-5593 Japan

Received: March 17, 2014; Accepted: March 18, 2014; Published: March 19, 2015

Keywords

Infiltrative shadow; Lung; Metastasis; Pancreas

Clinical Image

A 61-year-old female was admitted due to a persistent fever with the presence of abnormal shadows on a chest roentgenogram. Chest CT showed multiple infiltrates with contrast enhancement (Figures 1A and 1B). The infiltrates did not respond to systemic antibiotic treatment, and the bronchoalveolar lavage showed no pathogenic microbes. Meanwhile, the lung biopsy specimen revealed ductal development composed of mucin-producing cells with hyperchromatic nuclei. Immunohistochemical staining of the specimen showed the expression of neither thyroid transcription factor-1 nor surfactant protein-A. In addition, abdominal CT revealed a pancreatic mass (Figure 2), and the level of serum carbohydrate antigen 19-9 was elevated (409.4 U/ml). Therefore, we confirmed pancreatic cancer metastatic to the lung.

Figure 1: Chest CT shows multiple infiltrates with diffuse contrast enhancement (A; lung window, B; mediastinal window).

    

    
    

    

    Figure 1:  Chest CT shows multiple infiltrates with diffuse contrast enhancement (A; lung window, B; mediastinal window).

Figure 2: Abdominal CT shows a pancreatic mass containing a low-density area (arrow).

    

    
    

    

    Figure 2:  Abdominal CT shows a pancreatic mass containing a low-density area (arrow).

Lung metastases are found in one-third of patients with pancreatic cancer and are occasionally the initial manifestations of the disease [1]: however, pancreatic cancer uncommonly presents infiltrative shadows in the lung [2,3]. A delay in diagnosis for pancreatic cancer leads to a poor outcome. Therefore, clinicians should consider pancreatic cancer in the differential diagnosis of pulmonary infiltrates refractory to antibiotics.

References

  1. Lisa JR, Trinidad S, Rosenblatt MB. Pulmonary manifestations of carcinoma of the pancreas. Cancer. 1964; 17: 395-401.
  2. Tsitouridis I, Diamantopoulou A, Michaelides M, Arvanity M, Papaioannou S. Pancreatic metastases: CT and MRI findings. Diagn Interv Radiol. 2010; 16: 45-51.
  3. Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics. 2001; 21: 403-417.

Citation: Kushima H, Ishii H, Umeki K, Jo K, Takeno Y, et al. Pancreatic Cancer with Lung Metastasis Presenting with Chest Infiltrates. Austin J Pulm Respir Med 2015;2(1): 1021. ISSN:2381-9022