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please help my sister far from lung shadow


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I tried my best to translate my sister's exam report in english and post it here ask for more advanced medic advice or anything else for treatment.

37-year-old female patient, no smoking history

Chief Complaint:

Lung nodules found in 2 months(Aug 2010)

History of present illness:

Physical examination in August 2010 when the X-ray film prompted multiple lung nodules. Chest CT examinations showed bilateral pulmonary multiple nodules, multiple bullae in left lung, left lower plumonary cystic lesions, a small pneumothorax Symptoms. A fluid plane can be seen in cyst.

9 Sep 2010 PET-CT examinations showed bilateral pulmonary nodules and left lower plumonary cystic lesions. NO increase in glucose metabolism.

14 Sep 2010 CT guided needle biopsy in the left lower lung nodule. Usually no cough, sputum,hemoptysis, no cheat pain, wheezing and discomfort after activity.


Normal development, mild anemia, body superficial lymph node no enlargement, Skull features no exception, no chest deformity, no expansion of the heart border, neat rhythm,

Left pulmonary lung breath sounds a bit lower, no dry rales, no abnormal in right lung, liver and spleen no swelling, no ascites, no lower extremity edema, feet side arterial pulse is normal.

Personal history:

First birth, natural delivery,11 years after menarche, pregnancy 3 times, production 1 girl, no epidemic life history, no history of eating raw fish, cattle and sheep. There have been alternately used Mirena, oral Marvelon, Mifepristone drug history

Family history:

Father with hypertension, mother with breast cancer, uncle pass away due to bronchiectasis later infection 10 years ago.

Past medical/surgery history:

July 2000 laparoscopic guided surgery left ovarian cyst resection.

March 2002 caesarean section a baby girl.

November 2006 myomectomy.

April 2009 abortion

August 2009 functional uterine bleeding curettage

November 2009 hysterectomy

March 2010 closure of pelvic surgery racemose hemangioma

Special inspection (Blood Testing):

September 9, 2010 blood test (normal)

September 9, 2010 erythrocyte sedimentation rate (normal)

September 9, 2010 tumor markers (normal)

September 9, 2010 angiotensin Ⅰinvertase (normal)


1. Due to major hospitals in Beijing, a number of expert consultation and diagnosis is still not clear, the following diagnosis may be:

⑴ Congenital pulmonary cyst adenomyosis?

⑵ Primary pulmonary leiomyoma ?

⑶ lung metastases adenomyosis?

⑷ vascular leiomyomatosis (the same origin with racemose hemangioma)?

2. For the disease any effective treatment options?

3. At present time, the feasibility of using estrogen receptor inhibitors or vascular endothelial growth inhibitor?

PET/CT Inspection Report

Exam time :10/9/2010 sex: Female Age: 37

Image Finding:

Fasting state (fasting plasma glucose 5.5mmol/L), 1 hour after intravenous injection of drugs, excuted X-CT and PET-CT exam.

Nasopharyngeal morphology, structure and FDG uptake are normal. Narrow oropharynx and bilateral swelling of waldeyer ring, FDG uptake was increased in the the left partial nodular area, the size of nodule is about 1.6cm big, the FDG uptake increasing abnormally. SUV mean/maximum is about 6.3/9.1. Shows multiple bilateral cervical lymph nodes, slightly more to the left, Slightly abnormal FDG uptake increased, SUV mean/max value is 2.7/3.4. Futaba thyroid sizes increased but the density is normal, FDG uptake without abnormal changes, in cervical trachea center, bilateral pyriform symmetry.

Chest gallery is symmetry, trachea centered. varying sizes of nodules distributed in bilateral lung , nodule has clear boundary, most of the nodule density is uniform in the pleura, the larger of about 1.6cm, no significant FDG uptake. See the lower left lung large irregular cystic lesions showed multiple cystic, the interval could be seen, most of them with thin walls, small part of them with wall thickening, density is still uniform, the thickest of wall about 1.7cm, FDG uptake was still no significant change in abnormal increase. There was a liquid-air interface in the cysts, see also lower left lung with cavitary nodules, about 1.6cm, FDG uptake was no increasing. Scattered in both lungs with multiple thin-walled bullae shadow and rosette-like vesicles bubble shadow, no abnormal FDG uptake. Both hilar and mediastinal lymph nodes have no significant swelling. A limited pleural pneumothorax in the upper left. Heart shadow a little full, showing the physiological FDG uptake in myocardium.

Liver’s shape and size are normal, density of liver parenchyma is normal, FDG uptake without abnormal increase. Hilar and retroperitoneal lymph nodes no obvious abnormal increase of FDG uptake. Pancreas, spleen, bilateral kidney shape, size and density were normal. Liver, stomach, pancreas, spleen, kidney, intestine showed physiological FDG uptake.

Showed a change in pelvic surgery, absence of uterus and some accessories, surgical area, see sample soft tissue mass, irregular shape, size about 6.7 * 8.3 * 6.0cm, FDG uptake increased slightly, SUV values 1.1/1.2, cystic nodules in bilateral annex area, some showed multiple cystic, FDG uptake increased slightly, SUV value 2.3/2.8. No obvious pelvic lymph node enlargement within the film. Intestine, ureter, bladder showed physiological FDG uptake.

within the scan field, no clear osteolytic and bone destruction, FDG uptake without limited abnormal changes.

diagnosis opinion:

Uterine fibroids, pelvic surgery racemose hemangioma" review, and patient series of X films, CT, MR comparison,

1. Pelvic soft tissue mass, glucose metabolism increased slightly, bilateral cystic shadow in Annex area, part of the increased glucose metabolism, consistent with clinical symptoms, meeting the recurrence of racemose hemangioma..

2. Multiple pulmonary nodules, no increase in glucose metabolism, compared with the previous films,multiple pulmonary nodules quantity and size are increased, considering metastatic disease the possibility of metastatic uterine leiomyoma should be more considering.

3. Left lower lung with liquid-air levels cystic mass, without increased metabolism of glucose, given more possibility of benign lesions - congenital disease or granulomatous disease (congenital cystic adenomatoid malformation, pulmonary sequestration off, Wegener's granulomatosis), recommanded biopsy;

4. Multiple bullae, limitated pneumothorax;

Oropharyngeal swelling of the lymphatic ring the Department of multiple lymph nodes with fresh, glucose metabolism increased, considering the complications of inflammatory lymph node and inflammation ; bilateral thyroid swelling, recommend futher laboratory testing.

Any more recommendations or diagnosis please contact me Thanks in advance!

My email: yunsizzf@126.com

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Sorry I can't help but want to tell you we all "get it" here how scary this time is for you and your family. I don't see anything here that refers to cancer except perhaps "lung metastases adenomyosis?" Don't know what that last word is though.

You might try cancergrace.org. They have doctors there who are not permitted to diagnose but will respond to individual cases in general terms.

Good luck to you and your family. Post again when you get more info.

Judy in KW

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