RE: Atypical pulmonary metastases from pancreatic adenocarcinoma

We recommend Lin et al. (1) for their interesting article on a case of atypical pulmonary metastases from carcinosarcoma of the parotid gland, demonstrating the radiologic features of an air-space pattern and calcification. We concur with their study in considering this type of lesions a formidable diagnostic challenge in the patients with unknown extrapulmonary malignancies. We would like to lend more support to this study by offering our experience with a similar exceptional case of atypical pulmonary metastases from a different kind of primary tumor. Recently, a 71-year-old afebrile female patient was admitted to our emergency department presenting 1-month history of chest pain and nausea. The chest radiography showed multiple small nodules throughout both lungs. The contrast-enhanced CT scan of the chest revealed the cavitating nature and a miliary pattern of the nodules (Fig. 1). The patient was suspected for the advanced pulmonary tuberculosis, but the quantiferon blood test resulted negative. A body CT was performed to better understand the overall clinical condition, and a solid mass was detected in the pancreatic isthmus (Fig. 2). At this point, a bronchoalveolar lavage was ordered in order to clarify the nature of the lung lesions. Some neoplastic cells testing positive for CK17 and CK19 were retrieved and the conclusive diagnosis was the metastases of pancreatic adenocarcinoma