AJR 2004; 183:1841-1843
© American Roentgen Ray Society
Metastatic Colorectal Carcinoma: An Unusual Cause of Calcified Pulmonary Metastases
Eoin Kavanagh,
Tadhg Gleeson,
Gormlaith Hargaden and
Helen Fenlon
Mater Misericordiae Hospital Dublin D7, Ireland
Calcified pulmonary metastases are described in association with a variety
of primary neoplasms [1]. We
describe the case of a 61-year-old man with a primary colonic adenocarcinoma
who developed calcified pulmonary metastases while receiving palliative
chemotherapy.
A 61-year-old man presented to our institution in March 2002 complaining of
rectal bleeding and recently altered bowel habit. Endoscopy showed an annular
carcinoma in the descending colon. A staging CT scan of the abdomen and pelvis
revealed a large circumferential tumor on the left side of the colon and
multiple calcified hepatic lesions. At endoscopic biopsy, a moderately
differentiated adenocarcinoma was discovered. Sonographically guided liver
biopsy disclosed a metastatic adenocarcinoma consistent with a primary colonic
cancer. A CT scan of the chest obtained at that time revealed no abnormality.
The patient was treated with palliative chemotherapy (5-fluorouracil), and a
metallic stent was placed across the tumor in the descending colon.
A restaging CT scan obtained 6 months later showed multiple calcified
lesions in the liver, consistent with hepatic metastases that had not
increased in size (Fig. 5A).
This examination also revealed several new pulmonary nodules at the bases of
both lungs. A course of irinotecan hydrochloride was prescribed for the
patient as second-line palliative chemotherapy. On subsequent restaging CT
scans obtained 6 months later, the pulmonary nodules had increased in size and
were noted to contain areas of stippled calcification (Figs.
5B,
5C,
5D). Because the size of the
nodules had increased in the interval between the two CT examinations and
because the calcifications had a morphology similar to that seen in the
calcifications in liver parenchyma, biopsy was not indicated, and the
pulmonary lesions were reported as metastases.
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Fig. 5B. —61-year-old man with metastatic colonic adenocarcinoma. CT
scans obtained 6 months after A show calcified pulmonary metastases in
right upper lobe (B), left upper lobe (C), and right lower lobe
(D). These three nodules had increased in size over time and gradually
had developed increasing amounts of stippled calcification.
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Fig. 5C. —61-year-old man with metastatic colonic adenocarcinoma. CT
scans obtained 6 months after A show calcified pulmonary metastases in
right upper lobe (B), left upper lobe (C), and right lower lobe
(D). These three nodules had increased in size over time and gradually
had developed increasing amounts of stippled calcification.
|
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Fig. 5D. —61-year-old man with metastatic colonic adenocarcinoma. CT
scans obtained 6 months after A show calcified pulmonary metastases in
right upper lobe (B), left upper lobe (C), and right lower lobe
(D). These three nodules had increased in size over time and gradually
had developed increasing amounts of stippled calcification.
|
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Calcification within a pulmonary nodule is one of the criteria associated
with a benign diagnosis. Several extrapulmonary primary tumors, however, are
associated with calcified pulmonary metastases. These include osteogenic
sarcoma, chondrosarcoma, giant cell tumors, and papillary and mucinous
adenocarcinomas [1]. Other
causes of calcified pulmonary metastases include testicular and ovarian
tumors, medullary carcinomas of the thyroid, and cardiac angiosarcomas
[2,
3]. The pattern of stippled
calcification seen in our patient previously has been described as an
indicator of malignancy [4].
The pathogenesis of calcified pulmonary metastases remains unclear. One of the
proposed theories is that dystrophic calcification or ossification occurs in
areas of cellular necrosis, as is seen in pulmonary metastases during
chemotherapy. We conclude that enlarging calcified pulmonary metastases may be
seen in patients with primary colorectal carcinoma who are receiving
palliative chemotherapy.
References
- Maile CW, Rodan BA, Godwin JD, Chen JT, Ravin CE. Calcification in
pulmonary metastases. Br J Radiol1982; 55:108
–113[Abstract/Free Full Text]
- Semple J, West LR. Calcified pulmonary metastases from testicular
and ovarian tumors: a report of two cases with long survival.
Thorax 1955;10:287
–292
- Garcia Rio F, Alvarez-Sala R, Caballero P. Calcified pulmonary
metastases from a cardiac angiosarcoma. AJR1993; 160:1147
–1148[Medline]
- Webb WR. Radiologic evaluation of the solitary pulmonary nodule.
AJR 1990;154:701
–708[Free Full Text]
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