PMC3920431_01
CXR on initial presentation at other district general hospital.
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He initially presented to another district general hospital 1 year prior with fever and abnormality on chest radiograph (Fig 1).
(a) CXR on presentation to our hospital (b) CT imaging -lung window (c) CT imaging -soft tissue window.
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Chest radiography and CT examination (Fig 2(a),(b),(c)) revealed a 10 cm ovoid lesion in the left lower lobe adjacent to the pleura.
Adrenal metastasis with a blood filled appearance.
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A similar looking lesion was also noted in the left adrenal (Fig 3).
Image 1. Highly pleomorphic malignant epithelial cells of poorly differentiated non-small cell carcinoma. Numerous mitoses and areas of necrosis. H&Ex200. Image 2. TTF-1 positive staining. Neoplastic cells show a moderate to strong nuclear staining with TTF-1 in favour of adenocarcinoma and lung primary. TTF-1 immunoperoxidase x200.
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The biopsy confirmed metastatic adenocarcinoma suggestive of primary lung origin (Fig. 4).
Cerebral metastasis - appearance of a blood filled cavity.
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Imaging of the brain (CT followed by MRI) revealed a space occupying lesion in the left parietal lobe surrounded by moderate oedema (Fig 5).