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Pulmonary nodule after surgery for benign pituitary tumor

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I had surgery in June for a benign pituitary tumor. Prior to the surgery I had a standard per-op chest X-ray which did not show anything concerning. This week I had an x-ray for shoulder pain and the radiologist noted a "1.4 cm oval pulmonary nodgule in the upper left lobe" of my left lung. Given that there was no fining in June and it is already 1.4 CM 6 months later, how likely is it that this is cancer? I am scheduled to see my GP this week, but naturally I am very worried.

Category: Pulmonologist

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Category: Allergy and Immunologist
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To give a solid opinion I need some additional information. To give a definite opinion, i would like to know the margins ( SMOOTH or irregular), and whether there is bony invasion - as a cause of shoulder pain.

With your age being 34, a rapidly growing nodule in the lung, that is already 1.5 cm by now - I feel that it is not malignant, but a benign one. Usually ( though not a dictum) malignancy is a disease of an older age. any tumor that has a doubling time less than 30 days and more than 456 days are usually benign.

The next investigation is definitely a CT scan of chest, with a screening up to adrenals, and based on the CT findings, to decide the next and final step of investigation.

There is also a possibility that the small the lesion was initially missed on the Xray. As much as 45% lesions can be missed on chest x ray to be picked up by a CT only

So in conclusion I would say the best next step would be a CT (and Biopsy if needed). Xray based analysis will lead you anywhere and only will cause unnecessary anxiety.

Hope this helps.
Dr. Jacob George MD, FCCP

Patient replied :

Thank you for your reply, it does help to put my mind at rest. Couple more pieces of information. I am not a smoker and never have smoked. I was exposed to a fair amount of second hand smoke when I was kid being around my grandfather. The radiology report does not give an impression about the boarders on the X-ray. The doctor showed me the X-ray at the clinic and the nodule appeared to be almost perfectly oval with fairly clearly defined boarders. It was fairly faint. It appeared to be to be on the upper left side of the lung on the outside. The long axis of the oval seemed to be aligned perfectly behind on of my ribs. I see my doctor in a couple days and I assume he will order a ct scan. My question is, since this is a new finding on the X-ray compared to June, could it be an artifact. When they took the X-ray I was wearing a an undershirt and a button down dress shirt. They did not ask me to take off my shirt or put a gown on. Second, what kinds of benign process can produce a 1.4 cm pulmonary nodule showing up new from an X-ray six months ago. You information is reassuring because Dr. google seems to indicate the the faster the growth rate is indicative of cancer. I would like to thank you again for you time and attention. I learned about this from a follow up call from a prompt care doctor on Friday night and in the absence of being able to consult my regular doctor your expertise has helped to settle some of the more outrageous and fearful thoughts this sort of news stirs up. best Curt

Dear patient,

Glad to hear that your spirits are up. The basic pre requisite of a chest x ray is to avoid artefacts, wear a simple gown instead of a dress and take it in full breath.All these steps are vital to get a good image. A perfectly smooth nodule is 70 - 80 % times benign.

Another helpful idea will be whether it has any calcium in it or not. in that case it will be of bit more density( like your ribs). In up to 20% of instances, a lung nodule actually represents an artifact, chest wall lesion, or pleural abnormality. CT can define the morphology of the lesion better and suggest whether it is benign, malignant, or indeterminate. a spiculated or irregular margin, the presence of bubbly air collections , or cavities; and a diameter of more than 2 cm are suggestive of malignant lesions, while a diffuse/ central/ laminated, or popcorn calcification is probably benign. Sometimes, calcium invisible on plain radiographs can be seen only on thin-section CT.

Did the doctor attribute your shoulder pain to the presence of nodule? from your description, i think it cant be so.

Possibilities -
artefact is high on my list, especially with the new information that you didnt change dress.
Something missed on first x ray- as it was overlooked, being hidden by the rib is 2nd
New things - like an infection is possible.
and last chance would be a malignant lesion.
this can be and has to be cleared by a CT chest.
Any tumour that is fast growing can be malignant. but super fast lesions are usually benign!

Dr. google, never gives a personalized answer. it gives a suggestion to your query! :-) so you may have to modify your search. Try a research activity on solitary pulmonary nodules instead of "fast growing lung lesions". I hope that will help.

Dr. Jacob George P

Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
Dr. Jacob George Pulinilkunnathil and 4 other Medical Specialists are ready to help you

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