Metastatic only primitive neuroectodermal tumor: smoke without fire can be more dangerous

Multiple, diffuse, well circumscribed large pulmonary nodules as an incidental finding is pathognomonic for disseminated cancer. For all cancers, the lung is the second most common site of metastasis after the liver (1,2) and the most common for Ewing Sarcoma family of tumors (ESFT) (3). Disseminated disease at presentation signifies poor prognosis regardless of the cancer origin, however both the treatment regimen and treatment response as well as the ultimate outcome is highly dependent on the type of metastatic cancer, and thus the first step is to obtain tissue diagnosis. While less invasive strategies always appear to be less morbid, they can be non-diagnostic and prolong time to treatment. Definitive surgical biopsies are invasive but conclusive and, despite slightly higher morbidity, end up being more effective.