Multiple cavitating cannon ball metastasis with primary adenocarcinoma lung: a rare case report

Nafees Ahmad Khan, Huma Firdaus, Salauddin ., Mohammad Shameem


Multiple large round well circumscribed pulmonary nodules in lungs are known as cannon ball secondaries. There are malignant and non-malignant causes of cannon ball secondaries. In case of malignancy, they represent classical haematogenous dissemination to the lungs of a primary malignant tumor. Secondaries to lung from renal cell carcinoma and choriocarcinoma are necrotic. The less common primary tumors causing cannon ball secondaries to lung includes prostate carcinoma, synovial sarcoma, endometrial carcinoma and some gastrointestinal malignancies. Here we presented a very rare case, maybe first of its kind of multiple cavitating cannon ball secondaries where primary malignancy was in lung itself which was EGFR positive adenocarcinoma lung. This case was also rare as cavitation is largely a feature of squamous cell carcinoma lung both of primary and metastatic lung malignancy.


EGFR positive, Multiple lung nodules, Primary lung malignancy

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Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics. 2001;21(2):403-17.

Seaton A. Other pulmonary neoplasm and related conditions. In: Seaton A, Seaton D, Leitch AG, eds. Crofton and Douglas's Respiratory Diseases. 5th ed. Oxford: Blackwell science ltd; 2000.

Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, et al. Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome. Radiology. 2005;237(1):342-7.

Weisbrod GL, Towers MJ, Chamberlain DW, Herman SJ, Matzinger FR. Thin-walled cystic lesions in bronchioalveolar carcinoma. Radiology. 1992;185(2):401-5.

Weisbrod GL, Chamberlain D, Herman SJ. Cystic change (pseudocavitation) associated with bronchioloalveolar carcinoma: a report of four patients. J Thorac Imaging.1995;10(2):106-11.

Kolodziejski LS, Dyczek S, Duda K, Goralczyk J, Wysocki WM, Lobaziewicz W. Cavitated tumor as a clinical subentity in squamous-cell lung cancer patients. Neoplasma. 2003;50(1):66-73.

Armstrong P. Pulmonary Neoplasms. In: Adam A, Dixon AK, Grainger RG, Allison DJ, eds. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. Philadelphia, PA: Churchill-Livingstone/Elsevier; 2008.

Bristowe JS. Cancer involving pharynx, larynx,neighbouring lymphatic glands and lungs. Trans Path Soc Lond. 1871;22:132.

Farrell JT. Pulmonary metastasis: a pathologic, clinical, roentgenologic study based on 78 cases seen at necropsy. Radiology. 1935;24(4):444.

Minor GR. A clinical and radiologic study of metastatic pulmonary neoplasms. J Thorac Surg. 1950;20(1):34-42.

Cohen AG. Solitary pulmonary metastasis with detectable bronchial involvement appearing 91 years after resection of colon carcinoma. N Y St J Med. 1950:50:1848.

Wigh R, Gilmore FR. Solitary pulmonary necrosis: a comparison of neoplastic and inflammatory conditions. Radiology. 1951:56(5):708-17.

Salzman E, Reid JH, Ogura GI. Cavernous metastatic pulmonary carcinoma. Dis Chest. 1953;23(6):678-85.

Seaman WB, Arneson AN. Solitary pulmonary metastases in carcinoma of the cervix. Obstet Gynec. 1953:8(4):165.

Katzev H, Bass HE. Cavitation in metastatic pulmonary neoplasm. Dis Chest. 1955:27(2):225-7.

Gellman DD, Jelliffe, AM. Cavitating pulmonary metastases. Tubercle. 1957:38(4):280-4.

Curran JD, MacCarthy MTJ. Cavitary pulmonary metastases. J Fac Radiol. 1959:10:166.

Berger M, Thompson JR. Cavitary carcinomatosis of the lungs. Dis Chest. 1967:52(1):106-11.

Koh KB, Rogawski K, Smith PH. Cavitating pulmonary metastases from superficial transitional cell carcinoma of urinary bladder. Case report. Scand J Urol Nephrol. 1994:28(2):201-2.

Essadki O, Chartrand-Lefèbvre C, Finet JF, Grenier P. Cystic pulmonary metastasis simulating a diagnosis of histiocytosis X. J Radiol. 1998:79(9):886-8.

Cohen MC, Drut R. Persistent interstitial pulmonary emphysema-like cyst associated with metastatic synovial sarcoma. Pediatr Dev Pathol. 2000:3(4):391-3.

Nabi G, Sadiq M. Multiple bilateral cannon-ball lung metastases from carcinoma of the prostate: orchiedectomy induced remission. Med J Malaysia. 2002;57(1):111-3.

Kurian A, Lee J, Born A. Urothelial bladder cancer with cavitary lung metastases. Can Respir J. 2011;18(3):46-7.

Kumar K. Extensive cannon ball metastases : a case study of 49 years old bulgarian male. Open J Med Imaging. 2014;4(3):159-62.

Murakami S, Manabe S, Yamada K. A case of lung adenocarcinoma with multiple cavitary metastases. Japan J Clinic Oncol. 2015;45(5):504-5.

Agarwal R, Mukhopadhyay J, Lahiri D, Biswas A, Maity P. Cannon‑ball pulmonary metastases as a presenting feature of stomach cancer. Lung India. 2015;32(3):300-2.