An unusual presentation of multiple cavitated lung metastases from colon carcinoma

The authors describe an unusual presentation of multiple cavitated lung metastases from colon adenocarcinoma and discuss the outcome of a patient. The absence both of symptoms and other disease localizations, the investigations related to different diagnostic hypotheses and the empirical treatments caused a delay in correct diagnosis. Only a transparietal biopsy revealed the neoplastic origin of nodules.This report demonstrates that although lung excavated metastases are described in literature, initial failure to reach a diagnosis is common. We would like to alert clinicians and radiologists to the possibility of unusual atypical features of pulmonary metastases from colon adenocarcinoma.Typical radiologic findings of pulmonary metastases include multiple round variable-sized nodules, generally located in peripheral parenchyma and diffuse thickening of interstitial [1,2]. Among cases of multiple nodules detected with CT-scan, 73% were reported to be pulmonary metastases [3]. The characteristic radiological findings of primary tumors and differential diagnoses of atypical lung metastases are reported by J. B. Seo et al. [4].Consolidation with or without ground-glass opacity is the typical radiologic finding of lung metastases of adenocarcinoma from the gastrointestinal tract. Cavitating lesions are detected only in 4% of metastatic nodules and about 70% of them are due to metastatic squamous cell carcinoma. Lung excavated metastases from osteosarcoma are very rare and those from adenocarcinomas of various primary sites (gastrointestinal, breast, ovary, etc) are only occasional.Herein the authors report a case of excavated pulmonary metastases from colon adenocarcinoma, whose unusual presentation and the absence both of symptoms and other sites of disease caused delay of correct diagnosis.C.E., a 78 year-old Caucasian woman, underwent radical surgery for adenocarcinoma of the sigma (pT4, pN1, and G2). The patient presented a history of coronary heart disease, but at