1978 Volume 30 Issue 1 Pages 23-30
In lung cancers, the symptoms and signs due to metastatic lesions may be frequently more predominant than those due to the primary focus. Here reported is a case of lung cancer with unu sual initial manifestations.
The patient, a 60 years old housewife, non-smoker, complained of headache and nausea without any symptoms of the respiratory tract. Physical examinations revealed enlarged cervical lymph-nodes, slight neck stiffness and some signs of central nerve disturbances, but body temperature was normal.
CSF obtained by lumbar puncture was bloody and contained increased number of lymphocytes with abnormal cells probably malignant.
X-ray films showed a small tumor-l ike shadow with 15 mm diameter in the right upper lung field, as well as osteolytic changes in the left 8th rib, in the right iliac bone, as well as in the right tibia. The tumor-like shado w in the lung, supposed to be the primary focus, was very small in proportion to the numerous bone lesions. Autopsy revealed primary lung can cer, histologically adenoacanthoma with wide-spread metastases, although metastatic meningeal carcinomatosis was not confirmed, opening of her scalp not being allowed by the relatives of the patient.
