METASTATIC LUNG ADENOCARCINOMA PRESENTING AS A MULTIPLE SUBCUTANEOUS NODULES: A CASE REPORT

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: cancer is the leading cause of related deaths in United States [1][2][3]. The most common sites its metastasis include liver, adrenal gland, brain, bone, kidney and abdominal lymph nodes [1][2]. Metastasis cancers to soft tissues rare lung have an even lower prevalence cutaneous (1.3-4%) muscular (0-0.8%) [1]. We report a case young male with multiple subcutaneous nodules that had positive immunoprofile for metastatic focus adenocarcinoma. CASE PRESENTATION: Mr. P 36-year-old smoker who presented his PCP diffuse aches pains throughout body chronic low back pain 3 months associated unintentional 10lbs weight loss. He denied shortness breath, cough or hemoptysis. On examination, there was tender, firm, round, non-protruding mass right posterior abdomen non-tender, round protruding at side epigastrium. Right straight leg raise test positive. Lumbar MRI scan showed disc extrusion L4/L5 causing mild central canal stenosis. In addition, 5.5 x 2.0 1.6 cm lesion level L1 vertebral tissue (Figure 1). A follow up CT thorax, pelvis small masses anterolateral fat hemithorax, 3.8 3.4 rectus sheath necrotic 2), psoas muscle scattered abdomen. destructive left 9th rib extraosseous component also seen. There dominant hilar moderate narrowing upper lobe pulmonary arteries their branches. latter assumed be primary neoplasm. Biopsy retroperitoneal adenocarcinoma CK7 reactive CK20 nonreactive TTF1 reactive. This confirmed brain extensive lesions involving both cerebral hemispheres, pons cerebellar hemisphere peritumoral edema. Patient given high dose steroids subsequently started on whole radiation therapy. plan start concomitant chemotherapy management this aggressive tumor. DISCUSSION: Pain rapid growth skin are alarming signs signifying advanced disease regarded as grave prognostic indicators [3]. Preoperatively, our patient thought benign cyst any symptoms so no chest imaging obtained. incidental finding lumbar led further work up. CONCLUSIONS: highlights importance obtaining biopsy all masses, especially if they tender rapidly growing. REFERENCE #1: Perisano C., Marzetti E., Spinelli M. S., et al. Soft metastases cancer: review literature. European medical pharmacological sciences. 2012;16(14):1908–1914. #2: Yglesias B., Brooker M., DeVito R., Metastatic Adenocarcinoma Presenting Tissue Mass. reports surgery. 2021; 2021: 8856503. https://doi.org/10.1155/2021/8856503 #3: Baldeo Ali Seeram V., House J. presenting soft-tissue metastasis. oncology. 2015;8(1):185–188. doi: 10.1159/000381875. DISCLOSURES: No relevant relationships by Ammar Ahmed, source=Web Response Madeeha Banu, Aravind reddy Kuchkuntla, Azib Shahid, Belaal Sheikh,