Clinical images. Gastric perforation caused by metastatic lung carcinoma

Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis

Background

Gastric metastasis from lung cancer (GMLC) is a rare occurrence. The clinicopathological characteristics, outcomes, and prognostic factors remain largely elusive.

Methods

We conducted a systematic review on case reports and case series of GMLC by scanning MEDLINE, Embase, and ISI Web of Knowledge. Data involving the clinicopathological features, treatment, and outcomes were extracted and analyzed. Survival analysis was performed using Kaplan–Meier method. The Cox proportional hazards regression model was used to identify potential prognostic factors associated with survival. Furthermore, a case of metastatic gastric adenocarcinoma of pulmonary origin with epidermal growth factor receptor (EGFR) L858R+T790M mutation was also described and included.

Results

Seventy-eight records involving 114 cases (including ours) were finally included. The median age on admission was 65 years with a male predominance of 79.8%. Lung adenocarcinoma (42.1%), located in the right upper lobe (30.3%), was the most frequent primary tumor. Bleeding (36.7%) and abdominal pain (35.8%) were the two most common symptoms. Endoscopically, gastric lesions were typically presented as elevated lesions with or without volcano-like ulceration, or ulcerative lesions, mostly involving the gastric corpus. The median overall survival time and survival time after diagnosis of metastatic cancer were 11 months [95% confidence interval (CI): 7–14] and 4.5 months (95% CI: 3–9), respectively. The survival analyses revealed that surgical interventions (including lung surgery and/or abdominal surgery) and systemic therapy (including chemotherapy, radiotherapy, and/or targeted therapy) seemed to be positive prognostic factors for both overall survival and survival after diagnosis of metastatic cancer.

Conclusions

Clinicians should be alerted to the occurrence of gastric metastasis in lung cancer patients. Comprehensive evaluation and appropriate treatment for specific patients may improve the survival rate of GMLC patients.

Infected colonic mass revealing a lung adenocarcinoma

We report the case of lung adenocarcinoma revealed by infected colonic tumor in a 62-year-old man. An en bloc surgical resection was performed with uneventful recovery. The pathologic report concluded in a right mesocolic lymph node metastases from a mildly differentiated adenocarcinoma from pulmonary origin. GI metastases of lung cancer are described in the literature and are frequently asymptomatic in patient with a known primary cancer. In this patient, the complication of the metastases revealed the primary and immunochemistry permitted to adapt the systemic chemotherapy.

Hypocalcemia after Thyroidectomy: The Need for Improved Definitions

Introduction

Hypocalcemia and permanent hypoparathyroidism are important outcome measures after total thyroidectomy. The aim of this article is to identify and highlight the wide variation in the adequacy/definition of these complications as reported in the surgical literature.

Methods

Nineteen journal articles (2008) on complications of thyroidectomy and 17 journal articles (2002) on ‘prediction’ of postthyroidectomy hypocalcemia derived from a PubMed search were reviewed.

Results

Only 21% of studies of describing outcome and complications of thyroidectomy defined hypocalcemia, temporary/permanent hypoparathyroidism. 47% of studies on the early prediction of hypocalcemia failed to quote their normal range of serum calcium. When stated, the biochemical definition of hypocalcemia varied from 1.8 to 2.12 mmol/l. There is no consistent definition of post-thyroidectomy hypoparathyroidism.

Conclusion

There is no consensus apparent on literature review as to what constitutes post-thyroidectomy hypocalcemia and hypoparathyroidism. The need to benchmark and define appropriate outcome measures of thyroid surgery demands that this deficit is addressed.