Five lung nodules, four different pathologic findings: not all lung lesions are the same

Area of Science:

• Oncology
• Pulmonary Medicine
• Surgical Pathology

Background:

• Colon adenocarcinoma can metastasize to the lungs, necessitating accurate staging and treatment.
• Preoperative imaging, including high-resolution computed tomography (HRCT) and positron emission tomography (PET), is standard for detecting lung metastases.

Observation:

• A patient with colon adenocarcinoma presented with two suspected lung metastases.
• Surgical resection included these two lesions plus three additional nodular areas identified during surgery.
• Pathologic examination revealed four distinct diagnoses among the resected lesions.

Findings:

• The number of lung lesions was underestimated by preoperative imaging (HRCT and PET).
• Pathologic examination identified multiple, diverse diagnoses in the resected lung nodules.
• This highlights the potential discrepancy between imaging and definitive pathology.

Implications:

• Accurate pathologic examination of all detected lung lesions is vital for optimal treatment selection.
• Underestimation of lesion burden impacts prognosis and treatment decisions, including surgery versus alternatives like stereotactic radiotherapy or radiofrequency ablation.
• This case underscores the importance of thorough pathological assessment in managing metastatic colon cancer to the lungs.