TITLE:
A Rare Case of Diaphragmatic Mass: The Key to Diagnosis of a Lung Adenocarcinoma
AUTHORS:
Cláudia Rocha, Vera Clérigo, Lígia Fernandes, André Rodrigues, Dora Sargento, Glória Silva
KEYWORDS:
Diaphragmatic Metastasis, Metastatic Lung Adenocarcinoma, Muscle Metastasis
JOURNAL NAME:
Advances in Lung Cancer,
Vol.3 No.3,
September
10,
2014
ABSTRACT: 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.