MILIARY METASTATIC ADENOCARCINOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Miliary opacities are defined as innumerable 1- 4mm pulmonary nodules scattered throughout the lung fields. Differential for miliary pattern is wide including tuberculosis, fungal infection and distinct organ metastasis. We present a case of 37 year old male with seen on chest radiograph CT scan ostial lesion in his L2 vertebrae, who was initially thought to have TB Pott's disease later diagnosed primary adenocarcinoma spinal, brain calvarium CASE PRESENTATION: A 37-year-old no significant medical history presented ED 2 months lower back pain. He endorsed shortness breath 40 pound unintentional weight loss over 3 months. incarcerated 5 years ago at which time PPD negative.Chest x-ray showed diffuse bilateral infiltrates micronodular pattern. Following this, obtained evaluate pain pathological compression deformity consistent also left upper lobe mass.Given incarceration, loss, lumbar vertebra, tuberculosis Potts considered. QuantiFERON gold AFB sputum were obtained. After x3 negative studies it decided proceed bronchoscopy bronchoalveolar lavage (BAL).Lymph node biopsies BAL pathology reports came positive adenocarcinoma. Upon further investigation MRI spine noted that patient had Cavalier metastasis, frontal metastasis numerous enhancing bone lesions sacral osseous metastasis.Oncology radiation oncology consulted he started stereotactic therapy well right calvarial systemic chemotherapy immunotherapy. DISCUSSION: array conditions infectious etiologies like TB, histoplasmosis, other infections noninfectious from thyroid, renal, breast carcinomas, metastatic melanoma. There has been documentation patterns Langerhans' cell histiocytosis, hypersensitivity pneumonitis few cases cancers.History key component diagnosis especially patients coming areas populations where prevalent. Once ruled out approach rule malignancies should be perused. CONCLUSIONS: It impossible distinguish between solely based pattern, hence when definitive uncertain, tissue REFERENCE #1: Khan D, Danjuma M, Saddique U, Murshed K, A, H, Yassin A: Adenocarcinoma Mimicking Tuberculosis. Rep Oncol 2020;13:139-144. doi: 10.1159/000505685 DISCLOSURES: No relevant relationships by Sarasi Jayaratne, source=Web Response Gaurang Prabhu, Gaurav