PMC8349093_01
CT chest shows a solitary lung nodule in the right middle lobe (Panel A); CT abdomen at the level of the pancreas depicts normal-appearing pancreas and ducts (Panel B).
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A year prior to presentation, a computed tomography (CT) chest, abdomen and pelvis was obtained for unexplained abdominal pain which did not suggest any abdominopelvic pathology, but did reveal basal bilateral pulmonary nodules (Fig. 1).
A transbronchial right upper lobe nodule biopsy shows malignant glandular proliferation admixed with areas of fibrosis and inflammatory reaction, consistent with moderately differentiated adenocarcinoma (Panel A), while on immunohistochemical staining malignant cells are positive for CK7 and negative for CK20, TTF-1, CDX-2, GATA-3, PAX-8, WT-1, pan melanoma and HMB-45 (Panel B).
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Subsequently, a navigational bronchoscopy with biopsy of right upper lung nodule showed moderate to poorly differentiated adenocarcinoma (Fig. 2).
Multiple bilateral lung nodules (Panel A). Contrast enhanced PET scan shows multiple FDG avid lung nodules bilaterally with SUV values ranging from 4.1 to 5.6 (Panel B). A PET scan shows FDG avid area in the left fossa of Rosenmuller as well as near the aorta adjacent to the pancreatic body (Panel C).
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Fluorodeoxyglucose (FDG)- positron emission tomography (PET) scan showed FDG avid pulmonary nodules and FDG avid area in the left fossa of Rosenmuller as well as near the aorta adjacent to the pancreatic body (Fig. 3).
Fine needle aspiration (FNA) of pancreatic mass shows cellular aspirate with malignant ductal epithelial cells appearing singly and in clusters, consistent with well-differentiated ductal adenocarcinoma.
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Biopsy of the pancreatic mass showed well-differentiated adenocarcinoma consistent with an overall diagnosis of Stage IV pancreatic adenocarcinoma (Fig. 4).