Lung Cancer or Metastasis to Lung?

In this video, Sanjay Mukhopadhyay, MD, staff pathologist in the Department of Anatomic Pathology, presents a case of a patient with past history of endometrial adenocarcinoma as well as smoking. The case allows Dr. Mukhopadhyay to illustrate the differences in primary lung carcinoma and metastatic carcinoma to the lungs.

“The patient in this case was an elderly woman with multiple lung nodules at presentation, and she was a smoker… The patient had a history of endometrial cancer… eight years before the current presentation,” says Dr Mukhopadhyay. “So at that time… the patient had a FICO grade one endometrial adenocarcinoma with 90 percent biomaterial invasion, but a pelvic lymph node dissection was done. The lymph nodes were negative. She had… surgery plus radiation at the time but no other treatment and then she was well for the next eight years.”

Dr. Mukhopadhyay then describes the patient’s lung biopsy that clearly demonstrates an adenocarcinoma component as well as a squamous component. “The pathologic diagnosis was adenosquamous carcinoma and… the clinician thought that this was a probably lung primary, possibly with a dominant mass and the others slightly smaller,” he continues. “The patient refused treatment. She said that she didn’t want to undergo toxic chemotherapy. And now, the interesting part of the story starts… The patient went for eight years with this presumably advanced lung cancer without therapy and doing relatively well.”

The patient underwent another biopsy, this time with nuclear staining for PAX8, a technology that was unavailable at the time of her previous biopsy. This staining revealed that the tumor was likely gynecological, renal or thyroid.

“This is not lung cancer. This is actually a metastasis from the endometrial adenocarcinoma… This patient lived about 22 years out from the original uterine cancer diagnosis and 13 or 14 years after the first lung metastases,” notes Dr. Mukhopadhyay.

Watch the video above for more tips on how to distinguish primary lung cancer from lung metastases.