title: Excavated pulmonary nodules: an unusual clinical presentation of lung metastasis in two cases.
abstract: BACKGROUND
  Excavated pulmonary metastasis are rare. We present two cases of excavated pulmonary nodules proved to be metastases from osteosarcoma and gallblader lymphoma.
  
  
  METHODS
  The first one is 39-year-old man in whom cholecystectomy made the diagnosis of primary non-Hodgkin's lymphoma of the gallbladder. He presented in chest CT scan excavated nodules that had been biopsied and confirmed the diagnosis of non hodgkin lymphoma. He underwent 8 courses of chemotherapy CHOP 21 with complete remission. The second one is an 21 years old man who presented a right leg osteoblastic osteosarcoma with only excavated pulmonary nodules in extension assessment. He had 3 courses of polychemotherapy API (doxorubicin, platinum, and ifosfamide) with partial response. Unfortunately, he died following a septic shock.Review of the literature shows that excavated pulmonary nodules as metastasis are rare but we should consider this diagnosis every time we are in front of a cancer. Chest computed tomography is the best diagnosis imaging that could make this diagnosis. Differential diagnosis between benign and malignant bullous lesions is important because surgical excision affects survival in some malignancies.
  
  
  CONCLUSIONS
  Although pulmonary nodules are the most common cancer metastasis, a differential diagnosis of a concurrent primary malignancy should always be considered every time we have excavated lesions, even in patients with known malignant disease. Thorough chest evaluation is important, as multiple primary malignancies may occur concomitantly.
authors.affiliation: Department of Medical Oncology, National Institute of Oncology, Avenue Allal Alfassi, Hayriad, 10100 Rabat, Morrocco. wafallam@yahoo.fr
authors.forename: Wafa
authors.initials: W
authors.lastname: Allam
authors.forename: Basma
authors.initials: B
authors.lastname: Elkhanoussi
authors.forename: Khaoula
authors.initials: K
authors.lastname: Alaoui
authors.forename: Issam
authors.initials: I
authors.lastname: Lalya
authors.forename: Hassan
authors.initials: H
authors.lastname: Errihani
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D008223:Lymphoma / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D012516:Osteosarcoma / Q000150:complications / Q000175:diagnosis* / Q000556:secondary*; D011030:Pneumothorax / Q000175:diagnosis* / Q000209:etiology*; D003074:Solitary Pulmonary Nodule / Q000150:complications / Q000175:diagnosis* / Q000556:secondary*; D055815:Young Adult