Lahey Hospital & Medical Center, Burlington, MA, USA.
University of Oklahoma Health Sciences Center, Norman, USA.
J Investig Med High Impact Case Rep. 2023 Jan-Dec;11:23247096221150633. doi: 10.1177/23247096221150633.
Lung malignancy presentation with an uncommon metastatic site is a diagnostic challenge and often associated with poor prognosis. Nasal cavity is a rare metastatic site for any type of lung cancer. We report an unusual case of poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis presenting as a right vestibular nasal mass with epistaxis. A 76-year-old male patient with chronic obstructive pulmonary disease and 80 pack-year smoking history presented with spontaneous epistaxis. He reported a new rapidly growing right-sided nasal vestibular mass first noticed 2 weeks prior. Physical examination showed fleshy mass with crusting in right nasal vestibule along with a left nasal domus mass. Imaging revealed an ovoid mass in the right anterior nostril and a large mass in the right upper lobe of the lung (RULL) along with thoracic vertebral sclerotic metastasis and large left frontal lobe hemorrhagic lesion with severe vasogenic edema. Positron emission tomography scan showed large right upper lobe mass and suspected to be the primary malignancy along with widespread metastasis. Biopsy of the nasal lesion revealed poorly differentiated non-small cell carcinoma with squamous and glandular features. The diagnosis of very poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis was made. In conclusion, unusual metastatic sites with unknown primary lesions require a thorough diagnostic workup involving biopsy and extensive imaging. Lung cancer with unusual metastatic sites is inherently aggressive and associated with poor prognosis. Multidisciplinary treatment modalities should be employed keeping in view the functional status and comorbidities of the patient.
肺部恶性肿瘤以不常见的转移部位为特征，这对诊断构成了挑战，且通常与预后不良相关。鼻腔是任何类型肺癌的罕见转移部位。我们报告了一例罕见的肺低分化腺鳞癌病例，其广泛转移，表现为右侧前庭鼻肿块伴鼻出血。一名 76 岁男性患者，患有慢性阻塞性肺疾病和 80 包/年吸烟史，因自发性鼻出血就诊。他报告说，两周前首次发现右侧鼻腔前庭有一个新的、迅速生长的、右侧鼻腔前庭肿块。体格检查显示右侧鼻腔前庭有肉质肿块和结痂，同时左侧鼻腔穹窿有肿块。影像学检查显示右侧前鼻孔有一个卵圆形肿块和右肺上叶（RULL）的一个大肿块，以及胸椎体硬化性转移和左额叶大的出血性病变，伴严重血管源性水肿。正电子发射断层扫描（PET）显示右上肺叶有一个大肿块，疑似原发性恶性肿瘤，同时伴有广泛转移。鼻腔病变活检显示低分化非小细胞肺癌，具有鳞状和腺体特征。诊断为广泛转移的非常低分化肺腺鳞癌。总之，对于不常见的转移部位和未知的原发性病变，需要进行彻底的诊断性检查，包括活检和广泛的影像学检查。具有不常见转移部位的肺癌具有侵袭性，且预后不良。应根据患者的功能状态和合并症采用多学科治疗方法。
