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Hematogenous Metastases
Aletta Ann Frazier, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Bloodborne spread of cancer cells to lung (primary filtration organ)
                • Tumorlets may form within pulmonary arteries, interstitium, lymphatics, airways, pleura, lymph nodes

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            Selected References

                                            1. Frazier AA et al: A spectrum of metastatic disease in the chest: insights for the radiologist. Semin Roentgenol. 55(1):51-9, 2020
                                            2. Hang TX et al: Misdiagnosis of a multi-organ involvement hematogenous disseminated tuberculosis as metastasis: a case report and literature review. Infect Dis Poverty. 9(1):66, 2020
                                            3. Altorki NK et al: The lung microenvironment: an important regulator of tumour growth and metastasis. Nat Rev Cancer. 19(1):9-31, 2019
                                            4. Deniffel D et al: Differentiating intrapulmonary metastases from different primary tumors via quantitative dual-energy CT based iodine concentration and conventional CT attenuation. Eur J Radiol. 111:6-13, 2019
                                            5. Iftikhar A et al: Sarcoid-like reaction associated with renal cell carcinoma - a case report. Respir Med Case Rep. 27:100847, 2019
                                            6. Kaneko Y et al: Hilar and mediastinal sarcoid-like reaction after the treatment of malignant tumors: imaging features and natural course on 18F-FDG-PET/CT. Jpn J Radiol. 37(1):88-94, 2019
                                            7. Stowell JT et al: Thoracic manifestations of genitourinary neoplasms and treatment-related complications. J Thorac Imaging. 34(3):W36-48, 2019
                                            8. Bois MC et al: Neoplastic embolization to systemic and pulmonary arteries. J Vasc Surg. 68(1):204-12.e7, 2018
                                            9. Payá-Llorente C et al: Mediastinal sarcoid-like reaction in cancer patients. Pulmonology. 24(1):61-3, 2018
                                            10. Paku S et al: The evidence for and against different modes of tumour cell extravasation in the lung: diapedesis, capillary destruction, necroptosis, and endothelialization. J Pathol. 241(4):441-7, 2017
                                            11. Shroff GS et al: Imaging of metastases in the chest: mechanisms of spread and potential pitfalls. Semin Ultrasound CT MR. 38(6):594-603, 2017
                                            12. Holwerda RA et al: Thoracic metastases from primary hepatobiliary and pancreatic malignancies: predictable patterns of metastatic spread. J Thorac Imaging. 30(6):W82-91, 2015
                                            13. Paño B et al: Pathways of lymphatic spread in gynecologic malignancies. Radiographics. 35(3):916-45, 2015
                                            14. Hasleton P: Metastases involving the lungs. In Spencer's Pathology of the Lung. Cambridge University Press. 6th ed. 1375-407, 2013
                                            15. Martínez-Jiménez S et al: Imaging features of thoracic metastases from gynecologic neoplasms. Radiographics. 34(6):1742-54, 2014
                                            16. Brufau BP et al: Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted antiangiogenic therapy by using multidetector CT. Radiographics. 33(6):1691-716, 2013
                                            17. Eckardt J et al: Thoracoscopic versus open pulmonary metastasectomy: a prospective, sequentially controlled study. Chest. 142(6):1598-602, 2012
                                            18. Aquino SL: Imaging of metastatic disease to the thorax. Radiol Clin North Am. 43(3):481-95, vii, 2005
                                            19. Seo JB et al: Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics. 21(2):403-17, 2001
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Definitions

                                                          • Bloodborne spread of cancer cells to lung (primary filtration organ)
                                                          • Tumorlets may form within pulmonary arteries, interstitium, lymphatics, airways, pleura, lymph nodes

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      Selected References

                                                                                      1. Frazier AA et al: A spectrum of metastatic disease in the chest: insights for the radiologist. Semin Roentgenol. 55(1):51-9, 2020
                                                                                      2. Hang TX et al: Misdiagnosis of a multi-organ involvement hematogenous disseminated tuberculosis as metastasis: a case report and literature review. Infect Dis Poverty. 9(1):66, 2020
                                                                                      3. Altorki NK et al: The lung microenvironment: an important regulator of tumour growth and metastasis. Nat Rev Cancer. 19(1):9-31, 2019
                                                                                      4. Deniffel D et al: Differentiating intrapulmonary metastases from different primary tumors via quantitative dual-energy CT based iodine concentration and conventional CT attenuation. Eur J Radiol. 111:6-13, 2019
                                                                                      5. Iftikhar A et al: Sarcoid-like reaction associated with renal cell carcinoma - a case report. Respir Med Case Rep. 27:100847, 2019
                                                                                      6. Kaneko Y et al: Hilar and mediastinal sarcoid-like reaction after the treatment of malignant tumors: imaging features and natural course on 18F-FDG-PET/CT. Jpn J Radiol. 37(1):88-94, 2019
                                                                                      7. Stowell JT et al: Thoracic manifestations of genitourinary neoplasms and treatment-related complications. J Thorac Imaging. 34(3):W36-48, 2019
                                                                                      8. Bois MC et al: Neoplastic embolization to systemic and pulmonary arteries. J Vasc Surg. 68(1):204-12.e7, 2018
                                                                                      9. Payá-Llorente C et al: Mediastinal sarcoid-like reaction in cancer patients. Pulmonology. 24(1):61-3, 2018
                                                                                      10. Paku S et al: The evidence for and against different modes of tumour cell extravasation in the lung: diapedesis, capillary destruction, necroptosis, and endothelialization. J Pathol. 241(4):441-7, 2017
                                                                                      11. Shroff GS et al: Imaging of metastases in the chest: mechanisms of spread and potential pitfalls. Semin Ultrasound CT MR. 38(6):594-603, 2017
                                                                                      12. Holwerda RA et al: Thoracic metastases from primary hepatobiliary and pancreatic malignancies: predictable patterns of metastatic spread. J Thorac Imaging. 30(6):W82-91, 2015
                                                                                      13. Paño B et al: Pathways of lymphatic spread in gynecologic malignancies. Radiographics. 35(3):916-45, 2015
                                                                                      14. Hasleton P: Metastases involving the lungs. In Spencer's Pathology of the Lung. Cambridge University Press. 6th ed. 1375-407, 2013
                                                                                      15. Martínez-Jiménez S et al: Imaging features of thoracic metastases from gynecologic neoplasms. Radiographics. 34(6):1742-54, 2014
                                                                                      16. Brufau BP et al: Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted antiangiogenic therapy by using multidetector CT. Radiographics. 33(6):1691-716, 2013
                                                                                      17. Eckardt J et al: Thoracoscopic versus open pulmonary metastasectomy: a prospective, sequentially controlled study. Chest. 142(6):1598-602, 2012
                                                                                      18. Aquino SL: Imaging of metastatic disease to the thorax. Radiol Clin North Am. 43(3):481-95, vii, 2005
                                                                                      19. Seo JB et al: Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics. 21(2):403-17, 2001