Lung cancer is a
leading cause of death due to malignancy worldwide. Diaphragmatic metastasis
secondary to primary lung cancer is rare. In the literature, only a few cases
have been described as the majority of cases of diaphragmatic metastasis which are
secondary to gastrointestinal neoplasia. The authors report a rare case of diaphragmmatic
metastasis from a primary adenocarcinoma of the lung in a 76-year-old female
patient with no history of active or passive smoking with progressive worsening
fatigue, asthenia, malaise, and unquantified weight loss with three months of evolution,
associated with pleuritic chest pain and edema of the lower limbs for fifteen
days previous to hospital admission. Chest X-ray showed elevation of the right
hemi-diaphragm and thoracic-abdominal-pelvic computed tomography revealed a complex
multilobuled mass with neoformative characteristics intersecting the diaphragm
and invading the dome liver and the right lung region. Biopsy of the mass was performed
whose histological examination was consistent with moderately differentiated adenocarcinoma.
Immunohistochemical examination was positive for cytokeratin 7 and negative
forcytokeratin 20, suggesting primary lung tumor. A positron emission
tomography was performed without uptake in other locations. Diagnosis of adenocarcinoma
with diaphragmatic metastasis was then admitted and the patient started chemotherapy
with carboplatin and gemcitabine. The patient
died six months after the diagnosis. The authors also present a brief theoretical
discussion based on the current and scarce literature on this rare entity.
References
[1]
Araujo, A.T., Santos, A.C., Gomes, G.P., Barata, F., Munha, J., et al. (2013) Prevenir a Doenca-Acompanhar e reabilitar o doente. Relatorio Observatorio Nacional das Doencas Respiratorias.
[2]
Su, H.T., Tsai, C.M. and Perng, R.P. (2008) Peritoneal Carcinomatosis in Lung Cancer. Respirology, 13, 465-467.
http://dx.doi.org/10.1111/j.1440-1843.2008.01268.x
[3]
Di Giorgio, A., Sammartino, P., Al Mansour, M., et al. (2004) Lung Cancer and Skeletal Muscle Metastases. The Annals of Thoracic Surgery, 78, 709-711. http://dx.doi.org/10.1016/S0003-4975(03)01364-X
[4]
Kwas, H.H., Zendah, I. and Ghedira, H. (2013) Skeletal Muscle Metastases from Lung Cancer. Asian Cardiovascular and Thoracic Annals, 21, 741-743. http://dx.doi.org/10.1177/0218492312470571
[5]
Pelin Ozcan, K., Gonca, K.G., Oktay, S. and Orhan, O. (2011) Rare Thyroid Cartilage and Diaphragm Metastases from Lung Cancer Visualized on F-18 FDG-PET/CT Imaging. Cancer Research and Treatment Molecular Imaging and Radionuclide Therapy, 20, 70-72. http://dx.doi.org/10.4274/MIRT.019882
[6]
Jin, S.G., Chen, Z.Y., Chen, W.X., Huang, W., Yan, L.N. and Zeng, Y. (2010) Diaphragmatic Metastases from Colon Carcinoma Mimicking a Hepatic Neoplasm: Report of a Case. Chin Med J (Engl), 123, 1359-1360.
[7]
Lee, K.H., Yu, C.S., Namgung, H., Kim, H.C. and Kim, J.C. (2004) Isolated Diaphragmatic Metastasis Originated from Adenocarcinoma of the Colon. Cancer Research and Treatment, 36, 157-159.
http://dx.doi.org/10.4143/crt.2004.36.2.157
[8]
Kim, M.P. and Hofstetter, W.L. (2009) Tumors of the Diaphragm. Thoracic Surgery Clinics, 19, 521-529.
http://dx.doi.org/10.1016/j.thorsurg.2009.08.007