Presentation
Epigastric discomfort.
Patient Data
The liver shows innumerable hypoechoic lesions on a background of normal liver parenchyma, the largest is seen in segment VII measuring about 7.5 x 6.9 cm. These findings raised the possibility of metastatic disease, so further workup was done.
There are a few large lobulated matted posterior mediastinal heterogeneously enhancing soft tissue mass lesions with areas of necrosis obscuring the esophagus and narrowing its lumen, splaying the carina and narrowing the left main bronchus, measuring about 12 x 7.8 x 5.3 cm in CC, TS, AP dimensions.
Multiple enlarged mediastinum lymph nodes the largest seen in the prevascular area measuring about 1.5 cm in short axis.
There is a focal lobulated lesion seen in the posterior segment of the left lower lung lobe, surrounded by subtle ground glass opacity, measuring about 2.7 x 6 x 3.5 in AP, TS, CC.
Innumerable large hypoenhancing liver lesions, most of which show central necrosis. The largest measures 5.7 x 5.7 cm.
Case Discussion
Features were suggestive of matted posterior mediastinal nodes with primary lung lesion along with numerous hepatic metastases.
Pathology report as follows:
MICROSCOPIC:
Multiple liver core biopsies, show infiltration by sheets of malignant tumor cells, with hyperchromatic nuclei and minimal cytoplasm with many apoptotic bodies and mitotic figures.
Immunohistochemical stains including synaptophysin, CD56 and TTF1 reveal the tumor cells are positive for CD56 and synaptophysin and focally for TTF1.
The above features, in correlation with the radiological findings, are most consistent with metastatic small cell carcinoma of primary lung origin.
DIAGNOSIS:
Liver lesion, trucut biopsy: consistent with metastatic small cell carcinoma of primary lung origin.
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