Pulmonary Metastasis of Pleomorphic Liposarcoma Presenting as a "Ball-in-Hole" Lesion on Chest Radiograph-A Case Report

A 54-year-old man with a history of hepatocellular carcinoma and chest wall pleomorphic liposarcoma post-surgical excision presented with 1 month of hemoptysis. CXR revealed a ”ball-in-hole” lesion in the right upper lobe. CT scan of the chest revealed a 2.5 cm enhancing nodule at the anti-dependent portion of a 3.7 cm cavity within ground-glass opacity at the apical segment of the right upper lobe. Aspergilloma was suspected. Bronchoscopic examination failed to identify the lesion, so surgical excision was scheduled. Right upper lobectomy with mediastinal lymph nodes dissection was performed utilizing video-assisted thoracic surgery. The lesion was identified as a metastatic pleomorphic liposarcoma in the pathological study. The postoperative course was uneventful, and no recurrence was found 8 months after the surgery. This case illustrates a rare type of liposarcoma with metastasis to the lung, presenting with an unusual pattern on the CXR.