metastases to organs such as the liver , bones or central nervous system appear to be a frequent complication of lung cancer , whereas metastases to the suprarenal glands are found less frequently .
metastases of lung cancer to the spleen are a great rarity and they are described sporadically . an adrenal gland tumor detected incidentally during imaging tests is described as an incidentaloma [ 37 ] .
primary cysts acquiring enormous proportions and hemangiomas are classified as benign tumors [ 9 , 10 ] .
metastatic lesions and inflammatory pseudotumors may also be seen , but only very rarely and usually as casuistry [ 11 , 12 ] .
splenic lesions may be observed in the course of malignant lymphoma [ 13 , 14 ] .
lesions characteristic of sclerosing angiomatoid nodular transformation ( sant ) have also been described . in most cases ,
the typical characteristics of splenic tumors are established on the basis of histopathological findings , which are obtained by the surgical removal of the tumor or by post - mortem examination [ 8 , 10 , 1618 ] .
this work presents a case of simultaneous dissemination of lung cancer to the adrenal gland and to the spleen .
a female patient ( age 74 ) was sent from a hospital in zawiercie for further investigations and management of a left lung tumor lesion discovered during x - ray examination .
chest surgeons had rejected her from an invasive therapy . however , bronchoscopy was performed and revealed no evidence of pathological bronchial lesions . in this situation
the patient was sent to our hospital for the purpose of making the histopathological diagnosis ( history no .
16735/877/09 ) . computed tomography ( ct ) scan showed chest infiltration situated peripherally in the left lung . after establishing the distance , place and depth of the puncture by using ct ( fig .
1 ) , the parietal tumor was visualized by ultrasound and a biopsy was performed .
we performed an ultrasound - guided ( free hand technique ) fine - needle biopsy of the lesion using a hitachi eus 515 sonographic machine ( fig .
computed tomography imaging scan  establishing the distance , place and depth of the puncture ultrasound imaging scan  wall located left lung tumor 
biopsy needle the ultrasound examination of the abdomen revealed a pathological mass in the spleen and in the left adrenal gland ( fig .
we also performed in local anesthesia an ultrasound - guided ( free hand technique ) fine - needle biopsy of these lesions .
in our case small cell lung cancer was detected in the percutaneous biopsy of the left lung .
the same type of cancer as in the left lung was observed in both the adrenal gland and in the spleen ( metastases of small cell cancer ) .
imaging methods available to us showed no evidence of cancer metastases in other organs . in the existing literature
, we found only a few cases of lung cancer metastases to the spleen [ 2 , 17 , 18 ] .
simultaneous metastases of lung cancer to the adrenal gland and the spleen have never been described .
the case presented above shows that the metastatic lesion can sometimes be an accessible place to collect tissue for diagnosing the cancer pattern of the primary cancer site .
the case is exceptional because the spleen is an organ where lung cancer metastases are not frequently found , while metastases to the adrenal gland alone are common .
the case is also unique because the adrenal gland and the spleen are organs where finding concurrent metastases of lung cancer is very rare .
 metastases of lung cancer to such organs as the liver , bones or to the central nervous system appear to be a frequent complication of this disease . at the same time , metastases to the adrenal gland are found less frequently . 
 metastases of lung cancer to the spleen are a great rarity and they are described sporadically . 
 our report presents a unique case of left lung cancer with simultaneous metastases to the adrenal gland and to the spleen . 
 all the presented lesions were diagnosed by ultrasound guided biopsy and confirmed by histopathological examination.the patient received combined chemoradiotherapy . 
 she was closely monitored over an 18-month observation period following treatment . 
 no new metastases were reported . 
Introduction
Material and methods
Results and discussion
None