Artikel
The value of diagnostic VATS in suspected pulmonary metastases
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Veröffentlicht: | 14. Oktober 2013 |
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Gliederung
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Objective: Patients with multiple pulmonary nodules suspected for pulmonary metastases may cause considerable diagnostic as well as therapeutic problems despite the convenience of a simple VATS biopsy. This casuistic case report underlines the importance of multiple biopsies of pulmonary nodules in patients with a history of several different primaries.
Methods: A 73 ys old man with the history of two primary malignomas, rectal cancer and melanoma, was diagnosed during follow-up with multiple bilateral pulmonary nodules at chest CT with diameters of 8–15 mm. Four nodules were detected in the right and three nodules in the left lung. According to the radiological report all nodules had identical radiomorphological features. The patient was referred to our department for histological verification of his suspected pulmonary metastases. Peripheral localization of two of the nodules on the left side in the lingula and in the dorsal left lower lobe enabled us to perform diagnostic wedge resections by VATS.
Results: A peripheral nodule in the lingula was resected and frozen section revealed the diagnosis of metastatic melanoma. Despite identical radiomorphology we decided to resect also the second superficial nodule in the left lower lobe. Frozen section as well as final histology surprisingly revealed the diagnosis of a metastasis of rectal carcinoma.
Conclusion: Radiomorphological features do not provide sufficient specificity regarding dignity of lung nodules. VATS wedge resection of lung nodules suspected for pulmonary metastases provides definitive histological diagnosis and enables to decide appropriate further treatment. The unexpected discovery of pulmonary dissemination from two different primary tumors emphasizes the importance of multiple biopsies of pulmonary nodules in patients with a history of more than one primary. A review of the literature will be provided for discussion.