| PURPOSE: To determine the frequency of single lung metastasis, primary lung cancer, and benign lesions in patients with a solitary lung nodule and a primary extrapulmonary neoplasm(ETM-SPN),and further sought to deduce CT differential diagnosis value of ETM-SPN with a multivariate retrospective study.MATERIALS AND METHODS: The authors evaluated 99 patients (101 entries)with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule. The histologic characteristics of the nodule were correlated with those of the extrapulmonary neoplasm and with patient age .disease free interval btween extrapulmoanry malugancy and diagnosis of lung lesion, the diameter of the noduleor mass of the lung,pathological characteristic (such as squamous cell carcinoma or adenoid carcinoma), characteristic of imaging manifestations and smoking history. In all 101 entries , the CT scans were reviewed to confirm the solitary nature, size, and/or nodular morphology of the lesion. Two patients had two extrapulmonary malignancies, and each of these patients was entered into the database twice (once for each primary malignancy). Thus, there were 101 patient entries. The definite diagnosis was determine in all cases by the intraoperative pathological diagnosis .In 29 of the 101 patient entries, the cell type of the nodule was determined by means of percutaneous core biopsy (n = 12), cytologic biopsy (n = 11), or resection (n = 40), Vedio Assitted Thoracic Surgery(VATS,n=6),Fibroscopy (n=16),and Two patients were diagnosed by clinical course who were stability of size for at least 2 years or resolution without chemotherapy helped to establish a benign diagnosis. SPSS 10.0 package was used for statistic analysis. P>0.05 were used as signifcance standard.The data were analyzed first by using all data entries and second after the elimination of entries obtained from patients with multiple extrapulmonary primary malignancies.RESULTS: Of all 101 cases.There were 94(76.5%)cases of malignancy .including 48 cases (58.8%)of metastatic pulmonary tumour and 46 cases (17.7%)of primary lung cancer . The mean diameter of pulmonary lesions was 4.033cm 2.73cm(range,0.5 cm 18.5 cm ;median 4.00cm). The mean diameterof 46 cases of primary lung cacer and 48 cases of solitary metastasis lesions were 4.76?.60cm(range,0.7cm~12.0cm;median,4.10cm) and 3.50cm?.83cm(range,0.5~18.5cm;median, 3.00cm),respectively. the largest one with a diameter of 18.5cm mass was in a patient of melanoma which diagnosed under percutaneous needle biopsy. Of the 14 patients with a primary malignancy of the head and neck , 8 (57.1%) had a primary lung cancer, four (28.6%) had a metastasis, and two (14.3%) had a benign lesion. Of the 13 patients with a carcinoma of the breast, all of them were adenoid carcinoma, 10 (76.9%)patients were primary lung cancer, two(15.4%)had a metastasis. The other one(7.7%)which in the middle lober of the right lung resolution with antibiotics therapy and comfirmed a benign lesion of granuoma. In this study, there were 6 patients with a carcinoma of the esophagus, excepts one in anterior segment of right upper lobe conformed of a lesion of tuberculoma after thoractomy, all the others had a primary lung cancer. None of them had a metastasis. Of the 17 patients with a carcinoma of the duodenal, or stomach , 12 (70.6%,12/17) had a primary lung cancer, five (29.4%) had a metastasis. Of the 18 patients with a carcinoma of the colon, except 4 cases had a metastasis and one had a inflammatory granuoma, 13(72.2%,13/18) had a metastasis. Of the 10 with kidney(n=7), urinary bladder(n=3), 9 cases had a metastasis, in which all 7 of renal carcinom had a pulmonary metastasis,and two had a primary lung career. Of the 7 patients with hepatic cellular carcinoma , common biliary duct and head of pancreas.except one of hepatic cellular carcinoma had a primary lung cancer, all had a lung metastasis. There were 4 patients with ovary, uterus and uterine cervix carcinoma. Two of them had a primary lung cancer ,one had a metastasis of the muco-cystoadenal carcinoma. And t...
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