PMC8314683_01
(A) CT image and (B) postoperative pathology of lung adenocarcinoma 11 years ago. The yellow triangle indicates the location of lung adenocarcinoma.
OTT-14-4269-g0001.jpg
PMC8314683_01_OTT-14-4269-g0001.jpg
f0001
The patient had received lung lobectomy due to lung cancer in the right upper lobe 11 years ago (Figure 1A). Postoperative pathology showed a 4.0x3.9 x 3.0 cm moderately differentiated adenocarcinoma, with one positive mediastinal lymph node among all the 10 dissected lymph nodes (Figure 1B).
(A) MRI investigation with T2-weighted, arterial phase, venous phase images, and diffusion-weighted imaging (DWI), and (B) postoperative pathology of pancreatic mass 7 years ago. The yellow triangles indicate the location of pancreatic mass.
OTT-14-4269-g0002.jpg
PMC8314683_01_OTT-14-4269-g0002.jpg
f0002
CT assessment showed a pancreatic head mass with involvement of the distal common bile duct (Figure 2A). She was then treated with radical pancreaticoduodenectomy, where a 2.5x2.0 x 2.0 cm moderately differentiated adenocarcinoma with negative lymph node metastasis was removed (Figure 2B).
(A) CT investigation with non-enhanced, arterial phase, venous phase, and delayed phase images, and (B) postoperative pathology of liver mass 3 years ago. The yellow triangles indicate the location of liver mass.
OTT-14-4269-g0003.jpg
PMC8314683_01_OTT-14-4269-g0003.jpg
f0003
Four years after the Whipple procedure, a follow-up examination showed a solitary liver lesion in segment VII (Figure 3A). Postoperative pathology demonstrated a 3.0 cm segment VII adenocarcinoma and suggested the diagnosis of liver metastasis (Figure 3B).
(A) MRI investigation with T2-weighted, arterial phase, venous phase, and DWI images. The yellow triangles indicate the location of recurrent liver mass. (B) Similar morphology in the four heterochronous specimen, namely the lung adenocarcinoma 11 years ago, the pancreatic mass 7 years ago, the liver mass 3 years ago, and the recurrent liver mass. The red triangles indicate the acinar and tubular structures in the adenocarcinoma, and the blue triangles indicate the original tissue structures. The bars indicate 100 microm. (C) IHC studies on TTF-1 and (D) NapsinA expressions were performed in the four heterochronous specimen. The bars indicate 500 microm.
OTT-14-4269-g0004.jpg
PMC8314683_01_OTT-14-4269-g0004.jpg
f0004
Recently, the patient was admitted for the recurrence of a liver lesion, along with multiple lung nodules (Figure 4A). Liver biopsy confirmed adenocarcinoma, with similar morphology, such as the acinar and tubular structures, to the previous specimens (Figure 4B). Further immunohistochemical studies demonstrated that the lung adenocarcinoma eleven years ago, the pancreatic adenocarcinoma seven years ago, the liver adenocarcinoma three years ago, and current liver adenocarcinoma all shared features of positive thyroid transcription factor-1 (TTF-1, clone SPT24) and Napsin A expressions (Figure 4C and D), indicating the exact pathological origin of the lung adenocarcinoma.