title: [Focal metastatic symptom as the initial presentation of lung cancer--report of two autopsied cases].
abstract: From 1956 to 1985, autopsy was done on 17 lung cancer patients in our hospital. There were two patients with focal metastasis as the presenting symptom without any primary cancer manifestations. One patient was admitted for severe right epigastric pain followed by severe pain in the left epigastrium. The chest film revealed nothing except some indefinite inflammatory lesions in the left upper lung. The patient died of uremia in 6 months. A primary carcinoma of 2 cm in diameter in the left lower lung was found on autopsy, which widely spread to the right lung, ovaries, upper segment of the left ureter, peribronchial and periaortic lymph nodes. Histological diagnosis was poorly differentiated adenocarcinoma. The other patient had destruction of the sphenoid bone with cranial nerve paralysis and hypothalamic syndrome at first. The primary cancer, a poorly differentiated adenocarcinoma of 2 X 3 X 1.5 cm in size, was found in the right upper lung on autopsy. Focal metastatic symptom as the initial presentation of lung cancer is rare. These tumors, as small lesions, frequently occur in the peripheral part of the lung. However, the site in which the presenting symptom develops may not necessarily be the place prone to metastasis. The presenting symptom, in turn, would depend upon the tendency of causing symptoms in the involved site. The author suggests that careful searching and identifying of the pulmonary lesion be routinely done for patients with metastatic carcinomatous symptoms only.
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary*; D000328:Adult; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012888:Skull Neoplasms / Q000473:pathology / Q000556:secondary*; D013100:Sphenoid Bone; D014523:Urethral Neoplasms / Q000473:pathology / Q000556:secondary*