Pandiammal 24 / F

C/o Swelling B/L neck - 5 months

No fever / pain

H/o weight loss and loss of appetite

Menstrual History

Amenorrhoea - 6 months

2 children LCB - 1 ½ years

Not sterilized

Hb - 10.2 gms

TC - 14200 cells / cumm

ESR - 60

Biopsy – Acute on chronic lymphadenitis

USG – multiple hypoechoeic lesions in B/L kidneys. R > L

Paraaortic, aortocaval nodes enlarged

CT

BIOPSY

LN with sinus histiocytosis exhibiting pagocytic activity.

ADRENAL METASTASIS

4th MC site next to lung, liver and bones

MC primary sites – Lung, Breast, Skin, Kidney, thyroid and colon

UL / BL

Small / large

US – Hetrogenous echogenicity

Echogenicity < than surrounding fat

CT - Small – gland contour maintained

Homogenous

Necrosis / Hge - rare

Large - Distortion of gland contour Lobulated / Irregular in shape heterogenous (necrosis / Hge) Invasion of kidneys

DD Adenoma, Lymphoma Carcinoma - rare Hge Pheochromocytoma

PANCREATIC METS

Best diagnostic clue - masses in pancreas without pancreatic / biliary duct obstuction

Type of spread – Hematogenous – MC

Lymphatic

Direct

Etiology

RCC - 30%

Br. Ca – 23%

Breast Ca

Soft tissue sarcoma

Colonic Ca

CT - Solitary (MC) / multiple

Discrete masses (MC) / Diffuse

Homo / heterogenous

Hypo / ISO attenuation

coexists with mets in Liver, LN, Adrenal gland

Ductal dilatation – Un common

DD - Pancreatic ductal Ca

Islet cell tumour

Mucinous cystic pancreatic tumour