A 65 years old male patient, once a heavy smoker and HBV carrier suffers from some form of cancer with pericardial sac metastasis.The PET/CT shows there are four nodules with high SUVmax (higher then 2.5 ).One of them locates in the lower lob of right lung，16.2×10.9 mm in size，with SUVmax=3.5.The rest three nodules, adjacent to mediastina, are bigger in size(21.6×20.6 mm，33.4×18.8mm and 30.2×30.0 respecttively) and higher in SUVmax（ 8.7，5.8 and 7.1 respectively).All the other organs in the abdominal cavity are normal,except for liver.There is a nodule，24.3×18.2mm in size，with SUVmax=1.6. The IHC result of the cells collected from pericardial effusion shows：TTF-1(-)，Naspin-A(-)，CK5/6(-)，CD56(-)，Ki67(5% +)，CK7(+)，CK20(-)，P40(-)，Calretinin(-)，WT1(-)，PAX8(-)，TTF-1(-)，CDX2-88(-)，GATA3(-)，NKX3.1(-)，Claudin4(mostly+)，MOC31(-)，Syn(-).The question is what kind of cancer is it,a adenoma, squamous cell cancer or neuroendocrine tumors?The other question is the histological origin of these metastases, the lung or the liver?Can any one give me some advice？Thank you！
As there might be limitation in access to lung nodules for biopsy ( maybe a CT scan guided biopsy required), liver biopsy would be a potential way to give you more information based on pathology results.
Hello Arrhenius Lin
Apologies for not replying sooner about this very interesting case?
What was the eventual diagnosis (and how was this established) and what was the outcome?
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