Gastrointestinal metastases from primary lung cancer

Case Series Analysis of Diagnosis and Treatment of Gastrointestinal Metastasis in Lung Cancer Patients

Objective

This study was designed to investigate the clinical, pathological, endoscopic, and imaging characteristics of gastrointestinal metastasis in patients with lung cancer.

Methods

The clinical data of 20 patients with primary lung cancer with gastrointestinal metastasis.

Results

This study included sixteen men and four women, ranging in age from 31 to 75 years. The time interval from the diagnosis of lung cancer to the detection of gastrointestinal metastasis ranged from 13 to 142 months. The most common sites of metastasis were the small intestine (eight cases), colon (four cases), and upper gastrointestinal tract (eight cases). The major symptoms included obstruction, perforation, abdominal pain, abdominal distension, anorexia, and anemia. The predominant pathological type was poorly differentiated adenocarcinoma (seventeen cases). A single ulcer was mostly seen on endoscopy, and some cases showed a slight depression of the intestinal wall. The CT and PET-CT scan revealed bowel wall thickening, intraluminal polypoid masses, and intestinal perforation.

Conclusion

Gastrointestinal metastasis of lung cancer is mainly observed in the small intestine, colon, and stomach, and is often detected when severe complications such as gastrointestinal obstruction and perforation occurred. Regular evaluation of gastrointestinal conditions during lung cancer diagnosis and treatment is recommended to improve the diagnostic accuracy and prevent misdiagnosis.

Metastatic lung adenocarcinoma presenting with small bowel obstruction

Lung cancer is one of the most lethal solid organ malignancies. Metastasis commonly spreads to the liver, adrenal glands and bone. We report a case of a male patient who presented with an 8 week history of cramping abdominal pain and vomiting. Subsequent investigation revealed evidence of an obstructing small bowel lesion. He underwent a small bowel resection. Histopathology revealed evidence of lung adenocarcinoma as the likely primary disease. Although metastasis of lung adenocarcinoma to the small bowel is rare, early recognition may prevent potentially life-threatening sequelae including bowel perforation and peritonitis.

Stage IV non-small cell lung cancer with multiple metastases to the small intestine leading to intussusception: A case report

BACKGROUND

Gastrointestinal tract metastasis from lung cancer is rare and compared to small cell lung cancer (SCLC), non-SCLC (NSCLC) is even less likely to metastasize in this manner. Additionally, small intestinal tumors can also present with diverse complications, some of which require urgent intervention.

CASE SUMMARY

In this report, we detail a unique case of stage IV lung cancer, where the presence of small intestine tumors led to intussusception. Subsequent to a small intestine resection, pathology confirmed that all three tumors within the small intestine were metastases from adenocarcinoma of the lung. The postoperative follow-up period extended beyond 14 mo.

CONCLUSION

In patients with stage IV NSCLC, local tumor control can be achieved with various treatments. However, if small intestinal metastasis occurs, surgical intervention remains necessary, as it may improve survival.

Upper Gastrointestinal Bleeding Due to Metastatic Lung Adenocarcinoma in the Stomach and Duodenum

There are very few reports of bloodborne metastasis of lung adenocarcinoma to the gastrointestinal tract, primarily due to poor prognosis and short survival rate of metastasized carcinoma. We present a case of a 79-year-old man with a medical history of lung adenocarcinoma, who presented with complaints of weakness and melena for 1 week. He had symptomatic anemia, for which he was transfused with blood. Esophagogastroduodenoscopy showed a 10 mm sessile polyp in the gastric body that was removed. One month later, the patient presented with a similar complaint, and another esophagogastroduodenoscopy revealed 2 ulcerated lesions in the second portion of the duodenum. These lesions were treated by hemostatic clip placement and heater probe coagulation. Biopsy of lesions demonstrated thyroid transcription factor 1 and Napsin-positive tumor cells, consistent with lung adenocarcinoma. Owing to the poor prognosis of lung adenocarcinoma metastasizing to the lymph nodes, stomach, and duodenum, the patient was transferred to hospice care.

A Case of Primary Lung Adenocarcinoma With Metastasis to Colon Harboring EGFR Exon 19 Deletion

Lung cancer metastasizing to the colon is exceedingly rare and can present similarly to colorectal cancer. It is crucial to conduct further evaluations using immunohistochemical (IHC) stains and genomic testing to differentiate between the two and provide appropriate treatment without delay. Lung cancer generally has a poor prognosis, especially in cases with distant metastases. Although gastrointestinal (GI) metastases from lung cancer have been reported, cases of lung cancer manifesting as colon metastasis are extremely rare, with only a few instances documented.

Modulation of Gut Microbial Biomarkers and Metabolites in Cancer Management by Tea Compounds

Cancers are causing millions of deaths and leaving a huge clinical and economic burden. High costs of cancer drugs are limiting their access to the growing number of cancer cases. The development of more affordable alternative therapy could reach more patients. As gut microbiota plays a significant role in the development and treatment of cancer, microbiome-targeted therapy has gained more attention in recent years. Dietary and natural compounds can modulate gut microbiota composition while providing broader and more accessible access to medicine. Tea compounds have been shown to have anti-cancer properties as well as modulate the gut microbiota and their related metabolites. However, there is no comprehensive review that focuses on the gut modulatory effects of tea compounds and their impact on reshaping the metabolic profiles, particularly in cancer models. In this review, the effects of different tea compounds on gut microbiota in cancer settings are discussed. Furthermore, the relationship between these modulated bacteria and their related metabolites, along with the mechanisms of how these changes led to cancer intervention are summarized.

Case Report: Recurrent colonic metastasis from lung cancer-diagnostic pitfalls and therapeutic challenge of a peculiar case

Lung cancer (LC) mortality exceeds 20%, and detecting metastases from LC is becoming a challenging step in understanding the real prognostic role of specific localization. We report a case of a patient with lung metastasis to the colon with local recurrence at the anastomosis after radical resection for metastasis. In both cases, the diagnosis was on oncological follow-up, and surgery was offered in consideration of reasonable life expectancy, good control of LC, and high risk of intestinal occlusion. A 67-year-old male, with a history of LC 18 months ago, was referred to our surgical unit after a positron emission tomography CT total body, where an area of intense glucose metabolism (SUV max: 35.6) at the hepatic colic flexure was reported. A colonoscopy revealed an ulcerated, bleeding large neoplasm distally to hepatic flexure, almost causing resulting total occlusion. Histologic examination revealed a tumor with complete wall thickness infiltration, which appears extensively ulcerated, from poorly differentiated squamous carcinoma (G3), not keratinizing, with growth in large solid nests, often centered by central necrosis. Two of the 30 isolated lymph nodes were metastatic. The omental flap and resection margins were free from infiltration. The malignant cells exhibited strong positive immunoreactivity only for p40. The features supported metastatic squamous carcinoma of lung origin rather than primary colorectal adenocarcinoma. After 8 months from surgery, intense Fluorodeoxyglucose (FDG) uptake of tissue was confirmed in the transverse colon. Colonoscopy evidenced an ulcerated substenotic area that involved ileocolic anastomosis on both sides. Reoperation consisted of radical resection of ileocolic anastomosis with local lymphadenectomy and ileotransverse anastomosis. The second histologic examination also revealed poorly differentiated squamous carcinoma (G3), not keratinizing, with positive immunoreactivity only for p40, suggesting the origin of LC. This case report confirmed that the possibility of colonic secondary disease should be part of the differential diagnosis in asymptomatic patients and those with a history of LC diagnosis. In addition, relapse of colonic metastasis is infrequent but should be considered during follow-up of LC. More studies on colonic metastasis of LC are required to better understand the clinical features and outcomes.

Case Report: Genetic profiling of small intestine metastasis from poorly differentiated non-small cell lung cancer: report of 2 cases and literature review of the past 5 years

BACKGROUND

Poorly differentiated non-small cell lung cancer (NSCLC) is characteristic of high rate of distant metastasis and late stages at diagnosis. Small intestine metastasis is a rare but severe complication of lung cancer with a high rate of mortality. However, there is currently a lack of genetic profile studies on the small intestine metastasis of lung cancer.

CASE PRESENTATIONS

We present 2 cases of male patients in their 60s with primary NSCLC of low differentiation, initially with no distant metastasis detected. Biopsy samples were obtained from the primary pulmonary lesions, and both patients received systematic radiotherapy (RT) and chemotherapy. However, both cases presented with abdominal pain and distension, and immunohistochemistry of small intestine biopsy samples obtained by endoscopy confirmed lung cancer metastasis. Next generation sequencing was used to explore the genetic profiles from the biopsy samples of both the primary pulmonary lesions and small intestine metastases. The correlated genes responsible for the small intestine metastasis from poorly differentiated NSCLC in these 2 patients included TP53, LRP1B, and FGFR2. The reports of small intestine metastasis from poorly differentiated NSCLC with the past 5 years were systematically reviewed and summarized subsequently.

CONCLUSIONS

Poorly differentiated NSCLC with small intestine metastases, while rare, substantially impacts the prognosis and poses major challenges for diagnosis and treatment. Through comparisons of genetic profiles between patients and in the same patient before and after metastasis, we identified the mutations in genes such as TP53, LRP1B, and FGFR2, which were correlated with the occurrence and progression of poorly differentiated NSCLC, as well as its small intestinal metastasis. This discovery has the potential to guide clinicians in developing personalized treatment plans through the manipulation of targeted and radiation therapies.

Delayed Diagnosis of Duodenal Metastasis From Primary Lung Adenocarcinoma: A Case Report

The incidence of lung cancer metastasizing to the duodenum is rare, and its clinical presentation is still not fully understood due to its low frequency. It can be asymptomatic or present symptomatically in various ways. Here, we present the case of a 63-year-old female with an unusual case of duodenal metastasis from pulmonary adenocarcinoma, presenting with a new-onset seizure complicated by a fracture from a post-ictal fall. The diagnosis of anemia secondary to duodenal metastasis from lung cancer was delayed due to this sequence of events. The patient was ultimately found to have a circumferential mass in the third portion of the duodenum on esophagogastroduodenoscopy, which was found to be consistent with metastatic pulmonary adenocarcinoma on pathological examination.

Successful resection of colonic metastasis of lung cancer after colonic stent placement: A case report and review of the literature

BACKGROUND

Lung cancer is the leading cause of cancer deaths worldwide. Although lung cancer can metastasize to various organs such as the liver, lymph nodes, adrenal gland, bone, and brain, metastases to the digestive organs, especially the colon, are rare.

CASE SUMMARY

An 83-year-old man diagnosed with lung cancer received radiation and chemoimmunotherapy, resulting in a complete clinical response. One year after the initial lung cancer diagnosis, the patient presented with obstructive ileus caused by a tumor in the descending colon. An elective left hemicolectomy was successfully performed after the endoscopic placement of a self-expandable metallic stent (SEMS). Pathologically, the tumor of the descending colon was diagnosed as lung cancer metastasis. The postoperative course was uneventful, and the patient is in good condition 13 mo after surgery, with no signs of recurrence. The previous 23 cases of surgical resection of colonic metastasis from lung cancer were reviewed using PubMed to characterize their clinicopathological features and outcomes.

CONCLUSION

SEMS is useful for obstructive colonic metastasis as a bridge to surgery to avoid emergency operations.

Duodenal Metastasis From Primary Lung Adenocarcinoma: A Diagnostic and Therapeutic Challenge

Distant metastasis from primary lung cancer is mostly seen in the liver, brain, adrenal glands and bones. Small bowel, specifically duodenum is a relatively unusual site for distant metastasis from lung carcinoma. This case reports a rare scenario of upper gastrointestinal bleeding caused by duodenal metastasis by a primary lung adenocarcinoma. A 43-year-old woman presented to the emergency department with complaints of progressive hemoptysis for the past three weeks. Esophagogastroduodenoscopy (EGD) revealed a 2.5 cm x 2.5 cm fungating villous mass-like structure in the first portion of the duodenum, with a normal-appearing esophagus and stomach. Biopsies were performed, which were histologically consistent with poorly differentiated malignant. The immunohistochemical (IHC) staining was consistent with metastatic disease from primary lung adenocarcinoma. Due to its rarity, there are no solidified guidelines for the management of duodenal metastasis from lung carcinoma. Our case was challenging due to the extensive metastasis and low functional status of the patient and was ultimately managed with home hospice.

Lung carcinoma with small intestinal metastases and gastrointestinal bleeding: A rare case report

The occurrence of small intestinal metastases from primary lung cancer is rare. This report documents the case of a 57-year-old male patient initially diagnosed with non-metastatic lung adenocarcinoma, who presented with abdominal pain 6 months later. Postoperative pathological analysis confirmed the final diagnosis to be small intestinal metastasis from primary lung cancer. Thoracoscopic surgery and systemic chemotherapy were the preferred treatment options. However, the lung tumor spread to the small intestine, causing intestinal obstruction. As the patient could not tolerate anti-tumor therapy, only symptomatic treatment was provided. The patient experienced massive gastrointestinal bleeding and died the next day. Although small intestinal metastasis from lung cancer is rare and difficult to diagnose accurately, it should be considered when encountering a patient with lung cancer exhibiting abdominal symptoms and associated imaging findings. At this point, a pathological diagnosis should be performed immediately to determine the nature and source of the tumor. Furthermore, individualized treatment should be conducted in strict accordance with oncology guidelines. Of note, early detection and treatment are critical to ensure favorable outcomes.

[Duodenal bleeding due to metastasis from lung adenocarcinoma controlled by radiotherapy: A case report and literature review]

INTRODUCTION

Gastrointestinal (GI) metastases in lung cancer rarely occur.

CASE REPORT

We report here the case of a 43-year-old male active smoker who was admitted to our hospital for cough, abdominal pain and melena. Initial investigations revealed poorly differentiated adenocarcinoma of the superior-right lobe of the lung: positive for thyroid transcription factor-1 and negative for protein p40 and for antigen CD56, with peritoneal, adrenal and cerebral metastasis, as well as anemia requiring major transfusion support. Over 50% of cells were positive for PDL-1, and ALK gene rearrangement was detected. GI endoscopy showed a large ulcerated nodular lesion of the genu superius with active intermittent bleeding, as well as an undifferentiated carcinoma with positivity for CK AE1/AE3 and TTF-1, and negativity for CD117, corresponding to metastatic invasion originating from lung carcinoma. Palliative immunotherapy with pembrolizumab was proposed, followed by targeted therapy with brigatinib. Gastrointestinal bleeding was controlled with a single 8Gy dose of haemostatic radiotherapy.

CONCLUSION

GI metastases are rare in lung cancer and present nonspecific symptoms and signs but no characteristic endoscopic features. GI bleeding is a common revelatory complication. Pathological and immunohistological findings are critical to diagnosis. Local treatment is usually guided by the occurrence of complications. In addition to surgery and systemic therapies, palliative radiotherapy may contribute to bleeding control. However, it must be used cautiously, given a present-day lack of evidence and the pronounced radiosensitivity of certain gastrointestinal tract segments.

Gastrointestinal bleeding due to jejunal metastasis of pleomorphic lung carcinoma: a case report

Gastrointestinal metastasis of pleomorphic lung cancer presents with nonspecific manifestations, leading to delayed diagnosis. Herein, the authors report the case of a 56-year-old patient who presented with gastrointestinal bleeding due to pleomorphic lung carcinoma.

Case presentation

A 56-year-old patient presented to the emergency department with melena. On examination, he was hemodynamically stable. He had a sensitive and mobile mass in the periumbilical region. A thoracoabdominal computed tomography scan showed a mass of the right apical superior lobe measuring 4 cm and a lobulated jejunal mass measuring 10 cm. A percutaneous biopsy of the lung tumor revealed primary pleomorphic lung carcinoma. The authors performed a midline laparotomy and made a bowel resection with an end-to-end anastomosis. The postoperative course was marked by severe nosocomial pneumonia, leading to septic shock and death. The histopathologic examination concluded with a metastatic lesion of pleomorphic lung carcinoma.

Clinical discussion

The authors reported a rare case of jejunal metastasis of pleomorphic lung cancer. Pleomorphic carcinoma of the lung is a rare pathology that accounts for 0.1-0.4% of nonsmall-cell lung cancer. The prognosis is poor. In the presence of gastrointestinal bleeding caused by small bowel metastases of pleomorphic lung cancer, surgery is the treatment of choice.

Conclusions

Small bowel metastasis of pleomorphic lung cancer is rare. Surgical treatment is the treatment of choice. The authors highlight the importance of suspecting gastrointestinal metastases in patients with pleomorphic lung cancer in the presence of nonspecific digestive symptoms.

Intraluminal Small Bowel Metastasis From Primary Lung Cancer

Lung cancer is the leading cause of cancer-related death worldwide, with frequent metastases to the brain, liver, adrenal glands, and bone. The incidence of intraluminal small bowel metastases of the lung is extremely rare and poorly documented within the literature. Few case studies have been published since the late 1980s and early 1990s. However, little is known about this rare form of metastasis. Small bowel metastatic disease has atypical symptoms that mimic a variety of other diseases; as a result, signs and symptoms may be overlooked until the disease has progressed to a late stage. Signs of small bowel obstruction, symptomatic anemia, abdominal pain, and peritonitis are commonly reported signs and symptoms. Various modalities can be utilized for the workup of suspected small bowel metastasis, including positron emission tomography, computed tomography, and various forms of endoscopy. The prognosis for lung cancer patients with intestinal metastases is poor, with many only surviving months to a few years after diagnosis. Therefore, it is critical to consider small bowel masses as a differential diagnosis in a patient with primary lung cancer who demonstrates clinical signs consistent with symptomatic anemia secondary to gastrointestinal (GI) bleeding, peritonitis, or small bowel obstruction. We report an unusual case of intraluminal and fungating small bowel masses in a patient who had previously undergone lung resections and chemo-immunotherapy. She was diagnosed with non-small undifferentiated carcinoma with tumor necrosis over 12 years before disease recurrence in the bilateral lungs, right adrenal gland, bone, and small bowel. The discovery of the small bowel metastases occurred while undergoing treatment for advanced-stage disease. At this time, she completed chemo-immunotherapy and remained on maintenance immunotherapy. The patient also underwent a partial right adrenalectomy and radiotherapy to the right adrenal gland. Given that she was experiencing symptomatic anemia and further workup indicated that the GI masses were causing her anemia, she underwent palliative small bowel resection of the masses. The pathology results demonstrated that the masses originated from her primary lung cancer, confirming metastatic disease to the small bowel.

Successful control of intestinal bleeding from metastasis of pulmonary pleomorphic carcinoma with pembrolizumab: A case report

RATIONALE

Pulmonary pleomorphic carcinoma is a rare tumor with a poor prognosis and has no standard chemotherapy. We herein report a case of small intestinal metastasis of pulmonary pleomorphic carcinoma that resulted in intestinal bleeding and was successfully treated with pembrolizumab monotherapy.

PATIENT CONCERNS

A 54-year-old man with a history of pulmonary pleomorphic carcinoma resection was referred to our hospital due to a 1-month history of a fever and general fatigue.

DIAGNOSIS

Laboratory investigation revealed microcytic anemia. Hematochezia was also noted after admission. Computed tomography (CT) and positron emission tomography (PET)/CT at the time of this admission revealed intraperitoneal masses alongside the small intestine with no significant ascites.

INTERVENTIONS

Pembrolizumab (400 mg/body) was introduced as the first-line chemotherapy.

OUTCOMES

By the 15th day after the initial pembrolizumab administration, the fever had disappeared, and the intraperitoneal masses were markedly reduced. Hematochezia had also disappeared, and he no longer needed to receive blood transfusions.

LESSONS

To our knowledge, this is the first report in which small intestinal metastasis of pulmonary pleomorphic carcinoma was successfully controlled by pembrolizumab monotherapy. Immune checkpoint inhibitors may be promising therapeutic agents against pulmonary pleomorphic carcinoma.

Cetuximab and Dabrafenib Plus Trametinib for Untreated Colonic Metastasis of BRAFV600E Mutant Primary Lung Adenocarcinoma with Signet Ring Cell Features: An Interesting and Rare Case Report

Colonic metastases of lung adenocarcinoma are extremely rare. Signet ring cell adenocarcinoma (SRCA) has not been described in patients with gastrointestinal metastasis of lung adenocarcinoma. SRCA is a unique subtype of adenocarcinoma with strong invasion and a poor prognosis, and most SRCA found in the lung are due to gastrointestinal metastases. This report describes a rare case of colonic metastasis from primary lung SRCA. A 64-year-old female was admitted to Sun Yat-sen University Cancer Center for feeling of nausea and malaise. Following a positron emission tomography CT (PET-CT) scan, widespread metastases of tumor cells were found in the bilateral lung, liver, bone, and multiple lymph nodes, but there was no evidence of metastasis to the colon. Two months later, the patient received a liver biopsy at Tongji Hospital in Wuhan. Pathology revealed a poorly differentiated adenocarcinoma with SRCA conformation, but immunohistochemical staining did not identify the original source of tumor cells. Considering that SRCA mainly derives from the gastrointestinal tract and that serum gastrointestinal tumor markers were elevated, we performed gastrointestinal endoscopy on the patient. The results showed an isolated polyp in the colon, and the pathology results indicated a poorly differentiated adenocarcinoma that was considered to originate from the lung based on immunohistochemical staining. Meanwhile, genetic tests identified a BRAF V600E mutation. The final diagnosis was colonic metastasis of BRAFV 600E mutated lung SRCA. Considering the positive expression of EGFR in this case, cetuximab was innovatively added to the first-line treatment regime (dabrafenib and trametinib). To date, the patient has received thirty-two weeks of treatment. Interestingly, lung and liver tumors shrank and tumor markers in the blood normalized. Our findings offer valuable diagnostic and therapeutic information for colonic metastasis of BRAFV600E mutant primary lung adenocarcinoma with signet ring cell features.

Small Bowel Perforation Due to Rare Metastasis From Stage IV Lung Adenocarcinoma

Lung adenocarcinoma commonly metastasizes to the lymph nodes, bone, nervous system, liver, respiratory system, and adrenal gland. Metastasis to the small bowel is extremely rare and the literature deals mostly with few published case reports. We present a case of a 70-year-old male with a previous history of stage IV lung adenocarcinoma with brain and liver metastases treated with radiotherapy and chemotherapy. He presented to the emergency department with peritonitis and sepsis due to bowel perforation. He underwent an emergency exploratory laparotomy and small bowel resection. Surgical pathology revealed metastatic lung adenocarcinoma as the cause of bowel perforation. He tolerated and recovered from surgery well and was discharged on postoperative day 7. On one-month follow-up as an outpatient, he was doing well and had no complications or complaints from his recent surgery.

Colon metastasis from lung adenocarcinoma with BRAF V600E mutation: A case report

Symptomatic colon metastasis from primary lung cancer is rare in clinical practice. We report the case of a 58-year-old patient with advanced lung adenocarcinoma who developed abdominal symptoms, including abdominal distention and difficulty defecating, after immunotherapy and chemotherapy. The patient was diagnosed with lung adenocarcinoma, and systemic positron emission tomography-computed tomography confirmed multiple lymph node, pleural, and adrenal metastases. Molecular detection indicated BRAF V600E mutation and high programmed death-ligand 1 (PD-L1) expression. After first-line anti-programmed cell death protein 1 immunotherapy combined with chemotherapy, the nodes in the chest remarkably diminished. However, it was followed by colon obstruction, incomplete ileus, and bone metastasis. Endoscopic histological examination confirmed adenocarcinoma but could not identify primary or secondary tumors due to insufficient tissue. We performed colon resection to remove the obstruction, and postoperative tissue pathological microscopy confirmed metastasis from the lung adenocarcinoma. We corroborated the BRAF V600E mutation and high PD-L1 expression and supported the molecular features of lung adenocarcinoma. During hospitalization, the patient presented with unbearable pain in the bone metastases, and palliative radiotherapy was administered. Then, the patient received dabrafenib plus trametinib as the second-line therapy. This report discusses the clinical characteristics, pathology, imaging, molecular profile assessments, and treatment of primary lung adenocarcinoma with colon metastasis.

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.

Colonic polyp-rare site of metastasis from primary lung carcinoma: Clinical presentations and outcome

Although majority of lung cancers have distant metastasis at the time of initial diagnosis, colonic metastases are extremely rare. This report presents a rare clinical case which presented with lower limb deep vein thrombosis and found to have colon polyp incidentally detected while evaluating for occult blood positive in stool. Histopathology of the polyp was suggestive of lung primary and on further evaluation PET scan was suggestive of left lung mass with widespread distant metastasis.

Primary lung sarcoma with gastric metastasis and morphological divergence presenting as melena

A 61-year-old man was admitted to the medical intensive care unit following a 2-week history of weakness, lightheadedness and melena resulting in an acute anaemia. Upper endoscopy revealed multiple large gastric masses without evidence of active bleeding. CT of the chest revealed a large right upper lobe mass with bony destruction of the third rib and invasion into the anterior chest wall and mediastinum, as well as a soft-tissue density in the left kidney. Biopsy and histopathological review of both pulmonary and gastric masses revealed two distinct sarcomatous malignancies that, while both from a primary lung source, differed in their morphology. Natural history and behaviour are not well understood in sarcomas due to their rarity, but abdominal metastasis is considered an uncommon event in the progression of the disease. Gastrointestinal bleeding as the presenting symptom of a primary lung sarcoma is an atypical finding with no previously reported cases.

Colonic Metastasis of Primary Lung Cancer

The colon is an uncommon secondary site for metastasis of lung adenocarcinoma. Distinguishing primary colonic carcinoma from metastatic spread of lung carcinoma can be difficult. We present a case of a patient with lung adenocarcinoma who, on abdominal computed tomography scan examination, was found to have a sigmoid tumor that was thought to represent a synchronous primary colorectal adenocarcinoma. Histological examination of endoscopic sigmoid tumor biopsies confirmed this to be metastasis from the lung adenocarcinoma. The patient subsequently developed major rectal bleeding and deteriorated significantly. This case also illustrates the poor prognosis association with colorectal metastasis of lung cancer.

An Acute Jejunojejunal Intussusception Revealing a Metastatic Combined Lung Cancer

Intussusception is a relatively common disease in pediatric age but it is uncommon in adults. We report a case of a 49-year-old male who presented with an acute jejunojejunal intussusception revealed by abdominal pain and vomiting. He underwent an en bloc resection, and pathological findings concluded to a metastasis of a pulmonary combined small cell carcinoma and adenocarcinoma. A subsequent CT scan revealed the primitive mass of the right lung with no evidence of secondary localization. The biopsy was difficult to perform. The patient underwent a pneumonectomy with lymph node dissection confirming the same diagnosis. He made a good recovery from the surgery, and a postoperative chemotherapy was administrated, and he is in remission until this date.

A Rare Case of a Metastatic Lung Squamous Cell Carcinoma to the Large Bowel and the Liver

Lung carcinoma is the leading cause of death worldwide, with almost 50% of the patients presenting with distant metastases at the moment of diagnosis. The most common metastases sites are the lymph nodes, the liver, the adrenal glands, the bones, and the brain. The gastrointestinal tract was considered an unusual site for lung metastases, and due to the asymptomatic progress of the disease, they are usually diagnosed at a late stage. In the present case study, the clinical presentation, the treatment, and outcome of a rare case of descending colon and liver metastases from a lung squamous cell carcinoma in a 72-year-old female, two years after the presentation of her primary tumor are reported. The present study aims to increase the awareness for early diagnosis and treatment of metastatic lung cancer to the gastrointestinal tract.

Gastrointestinal hemorrhage caused by duodenal metastasis from a primary lung adenocarcinoma: A case report

The present case study reported a rare case of duodenal metastasis from a lung adenocarcinoma. A 62-year-old male, who underwent radical lung cancer surgery two years ago, was readmitted to Guangzhou Red Cross Hospital complaining of epigastric pain. The esophagogastroduodenoscopy identified a 2.5x3.5 cm ulcerative lesion at the duodenum. Histopathological and immunohistochemical staining results confirmed that the lung adenocarcinoma had metastasized to the duodenum. The tumor cells were positive for cytokeratin-7, thyroid transcription factor-1 and napsin-A expression, but negative for caudal-related homeobox 2 expression. Prior to the second cycle of targeted treatment with anlotinib, the patient reported severe hematochezia. Therefore, an angiography and artery embolization were subsequently performed. However, the patient succumbed to acute kidney injury three days after the operation. The metastasis of lung cancer to the gastrointestinal tract is extremely rare and usually asymptomatic. However, when treating patients with lung cancer presenting with digestive symptoms or other distant metastatic sites, clinicians should consider the possibility of gastrointestinal metastasis so that it can be identified in a timely manner. If lesions exist, doctors should locate these and perform biopsies to conduct histopathological and immunohistochemical examinations to make a clear diagnosis.

Gastrointestinal tract metastasis of lung cancer: The PD-L1 expression and correlated clinicopathological variables

The gastrointestinal tract is a rare site for metastatic lung cancer. Programmed cell death-ligand 1 (PD-L1) expression in lung cancer is a biomarker for the response to anti-PD-1/PD-L1 therapy. We investigated clinicopathological features and PD-L1 expression in 25 gastrointestinal metastatic tumors from the lung and primary adenocarcinoma of the small bowel. The small bowel was the most common site (16/25; 64%) of gastrointestinal tract lung cancer metastasis. A total of 19 (76%) of the gastrointestinal metastasis showed PD-L1 expression in ≥5% of tumor cells, with 14 (56%) showing high expression levels (≥50%). In contrast, 21 (84%) expressed PD-L1 in ≥5% immune cells, including 4 (16%) showing a high expression levels (≥50%). The PD-L1 expression on tumor cells and immune cells in primary lung cancer and corresponding gastrointestinal metastasis was concordant in 13 (68%) and 11 (58%) of the 19 paired cases, respectively. Small-bowel metastasis of lung cancer was characterized by a higher incidence of perforation (31% vs. 0%), ulcerated mass (83% vs. 60%), and neoplastic PD-L1 expression (75% vs. 0%) compared to primary small-bowel adenocarcinoma. Gastrointestinal metastasis from lung cancer might be a potential target for immune checkpoint inhibitor therapy, given its high expression of PD-L1.

Usefulness of a colonic stent for colonic obstruction caused by lung cancer metastasis

The gastrointestinal tract is not a common site for metastasis from lung cancer, and colonic metastases are especially rare. Although surgical intervention can improve colonic obstruction, perioperative mortality is high in patients with advanced malignancy, and these patients experience a significant deterioration in quality of life postoperatively. This report describes an uncommon case of colonic metastasis from non-small cell lung cancer (NSCLC), in which colonic obstruction was improved with a self-expanding metallic stent.A 62-year-old man was admitted to our hospital for progressively worsening abdominal pain. He had been treated with immunotherapy and chemotherapy after being diagnosed with NSCLC (T4N2M1) 1.5 years earlier. Enhanced computed tomography showed intestinal obstruction and a mass in the colon at the hepatic flexure. Histopathological analysis of a biopsy specimen confirmed NSCLC metastasis. Considering his general condition, endoscopic stenting was chosen as an urgent decompression procedure. He was discharged 45 days after stenting and was able to resume immunotherapy.Emergent stenting could be offered at experienced centers when operative intervention is not part of the treatment plan, as it is safe and improves the efficiency of care along with the quality of life.

Peritonitis from perforated sigmoid mass as the first manifestation of metastatic squamous cell lung cancer: a case report and review of literature

Lung cancer (LC) is an aggressive malignancy with early metastatic spread and poor prognosis. Gastrointestinal metastases from primary LC are extremely rare with highly variable presentations. In this report, we review the case of a patient who presented with peritonitis secondary to perforated sigmoid mass as the first manifestation of metastatic squamous cell LC.

Metastatic large cell carcinoma of the lung: A rare cause of acute small bowel obstruction

Here, we report a case of acute intestinal obstruction as the initial presentation of primary lung cancer in a male patient. Abdominal computed tomography (CT) showed multiple polypoid masses and regional lymphadenopathy with small bowel obstruction. The patient underwent emergency surgery for multiple luminal malignancy with mesenteric masses. According to the various clinicopathological features, the tumor was confirmed to be metastatic large cell carcinoma originating from the lung. Large masses in the left lower lobe of the lung were identified on the chest CT after emergency surgery, and non‐small cell lung cancer (NSCLC), not otherwise specified (NOS), was finally diagnosed on biopsy through bronchoscopy.

Pancreatitis and Biliary Obstruction Secondary to Duodenal Metastasis from Rapidly Progressing Lung Adenocarcinoma Treated with Common Bile Duct Stenting

Non-small cell lung cancer (NSCLC) is characterised by diffuse metastases, with common sites being the brain, liver, bones, and adrenal glands. Small bowel metastasis from NSCLC is a rare phenomenon, particularly in patients with an adenocarcinoma histology. We report the case of a 56-year-old lung adenocarcinoma patient with a duodenal metastasis diagnosed on FDG/PET-CT and confirmed on duodenal biopsy. Although initially asymptomatic, he subsequently presented with obstructive jaundice secondary to rapid local disease progression at the duodenal metastasis, requiring endoscopic intervention for biliary drainage. He was commenced on single agent pembrolizumab, with disease response on subsequent follow-up. This case highlights a rare case of gastrointestinal metastasis from NSCLC requiring endoscopic intervention due to rapid progression of the disease at the site of metastasis.

18 F-FDG PET/CT imaging of small intestinal metastasis from pulmonary sarcomatoid carcinoma: Brief report and review of the literature

We herein report two cases of small intestinal metastasis from pulmonary sarcomatoid carcinoma (PSC) detected by ¹⁸F‐fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F‐FDG PET/CT). We reviewed the literature on ¹⁸F‐FDG PET/CT features in gastrointestinal metastasis of PSC patients since 1992, and further analyzed the imaging features. According to the literature review, 23 eligible cases were identified from eight studies, and no cases underwent ¹⁸F‐FDG PET/CT imaging. In this study, clinical and PET/CT imaging data of two patients are reported. In our cases, clinical and the CT images of lung masses were not typical, but the uptake of ¹⁸F‐FDG was remarkably high, with SUVmax exceeding 30. Small intestinal metastases may not be related to obstruction, or even the local intestinal cavity may be dilated. Therefore, in PSC patients with mild or without abdominal symptoms, ¹⁸F‐FDG PET/CT imaging could identify intestinal metastasis at a relatively early stage and may be used to determine the preferred biopsy site, or early intervention by surgery.

Key points

¹⁸F‐FDG PET/CT imaging of small intestinal metastasis of PSC has not been previously reported in the literature and here we report the ¹⁸F‐FDG PET/CT features of two cases.

The uptake of ¹⁸F‐FDG was remarkably high in both the primary tumor and metastatic intestinal lesion. ¹⁸F‐FDG PET/CT imaging may therefore be used to determine the preferred biopsy site or early intervention by surgery.

A Rare Presentation of Poorly Differentiated Lung Carcinoma with Duodenal Metastasis and Literature Review

Lung cancer is a common malignancy which is frequently found to metastasize to distant sites including bone, liver, and adrenal glands. There are rare reports of metastases to the gastrointestinal (GI) tract, with the duodenum being the most uncommon. We present a rare case of a poorly differentiated lung carcinoma metastasizing to the duodenum. This case enhances the medical literature as it provides additional distinct features to the clinical and histological presentation of metastatic lung carcinoma to the GI tract. A 61-year-old male with a history of poorly differentiated lung carcinoma presented with worsening dizziness, fatigue, and early satiety. He had extensive workup done in the past for hemoptysis including a computerized tomography scan of the chest which showed a new lobulated, apical lesion and hilar lymphadenopathy. He ultimately had a transthoracic fine-needle aspiration (FNA) of the mass and was later diagnosed with poorly differentiated lung carcinoma. On examination, the patient was noted to be pale, tachycardic, and hypotensive. The patient was noted to have an acute drop in his hemoglobin requiring fluid resuscitation, multiple blood transfusions, and evaluation with an esophagogastroduodenoscopy. He was found to have an oozing ulcer in the third portion of the duodenum whose biopsies showed poorly differentiated carcinoma with areas of neuroendocrine differentiation, similar to his lung biopsy results, which was consistent with metastatic lung carcinoma.

A noteworthy treatment of metastatic small-cell lung cancer with afatinib, followed by subsequent development of rare metastatic lesions in the ascending and sigmoid colon

BACKGROUND

Small-cell lung cancer (SCLC) represents a group of highly fatal diseases with a tendency toward fast growth, early metastasis, and easy development of chemotherapy resistance. In the past 30 years, few advances have been made in the systemic treatment of SCLC, and cisplatin/etoposide has remained the standard of care for limited-stage SCLC and, in combination with radiotherapy, extensive-stage SCLC. The preferred metastatic sites of SCLC include the brain, liver, adrenal glands, bone, and bone marrow. However, bowel metastasis caused by SCLC is extremely rarely proved in patients while they are still alive (although autopsy studies suggest that silent metastases to the bowel are more common), and the standard treatment for bowel metastasis has never been reported. The mean time between the identification of gastrointestinal metastasis and mortality in patients with lung cancer is 100.6 days, with a range of 21-145 days.

CASE

We report the case of a patient with extensive SCLC (including brain metastasis), in which exon 19 deletion of epidermal growth factor receptor (EGFR) was detected. She initially refused chemotherapy and cranial radiotherapy and instead only agreed to oral target therapy. The second-generation EGFR-tyrosine kinase inhibitor (TKI), afatinib, was administered to the patient, and partial remission, including smaller metastatic brain tumors, was noted. Even though the subsequent development of rare metastatic lesions in the ascending and sigmoid colon was proved by colonoscopic biopsies, the prolonged overall survival (400 days) without standard treatment was marked in this case.

CONCLUSION

The patient with extensive metastasis of SCLC did not receive standard systemic chemotherapy. Instead, she initially received second-generation EGFR-TKI afatinib alone and later on whole brain radiotherapy as well (3 weeks before she expired). The prolonged overall survival of 400 days was marked and is worthy of sharing and further investigation.

Metachronous rectal metastasis from pulmonary adenocarcinoma after 11 years of chemo-, immuno-, and radiotherapy for recurrent lesions: a case report

Background

Rectal metastasis from pulmonary adenocarcinoma is rare, and it has been regarded as an end-stage phenomenon. Recently, however, advances in lung cancer treatment have improved the chance of long-term survival of patients with unresectable distant metastases. We describe the occurrence and management of metastatic spread of a pulmonary carcinoma to the rectum.

Case presentation

The patient was a 79-year-old woman who had undergone thoracoscopic left lobectomy for pulmonary adenocarcinoma and then, over the next 11 years, various drugs (carboplatin + paclitaxel (as adjuvant therapy), gefitinib, gemcitabine + vinorelbine, S1 (an oral 5-fluorouracil-based drug), carboplatin + pemetrexed + bevacizumab, erlotinib, nivolumab, afatinib, and carboplatin+ S1) were administered, especially for hilar and mediastinal lymph node recurrences. During the eleventh postoperative year, left and right iliac bone metastases were detected, and radiation therapy was undertaken for local control of these lesions. When ¹⁸F-fluorodeoxyglucose positron emission tomography was performed for evaluation of the disease, tracer accumulation in the upper rectum was seen. Colonoscopic examination of the rectum revealed an intramural mass with central ulceration, and the mass was diagnosed histologically as an adenocarcinoma. The bone metastases appeared to be controlled, and the patient’s performance status was good, but she had suffered constipation for about a year and desired treatment. Thus, laparoscopic low anterior resection was performed. Histopathologic analysis revealed a moderately differentiated adenocarcinoma existing mainly between the submucosa and serosa, and immunohistochemical analysis showed the tumor to be positive for cytokeratin (CK) 7, negative for CK20, positive for thyroid transcription factor-1, and negative for special AT-rich sequence-binding protein 2 and caudal type homeobox 2, confirming the diagnosis of rectal metastasis from the primary pulmonary adenocarcinoma. The patient recovered well without any change in her functional status. Systemic chemotherapy was resumed, and she continues to do well, now 6 months after surgery.

Conclusions

Surgery may be a good option for the management of an isolated rectal metastasis from pulmonary cancer in patients whose functional status is good.

Upper Gastrointestinal Bleed due to Duodenal Metastases of Lung Adenocarcinoma: Report of Two Cases and Review of Literature

Upper gastrointestinal bleeding as a result of gastrointestinal metastases from lung cancer is extremely rare. We report two cases of patients with duodenal metastases from lung adenocarcinoma presented with recurrent melena. Histopathological examination and immunohistochemical staining of the duodenal biopsies supported the diagnosis of metastatic lung adenocarcinoma.

Surgical treatment of intraperitoneal metastases from lung cancer: two case reports and a review of the literature

BACKGROUND

Peritoneal metastases are often reported in several abdominal tumors. Peritoneal diffusion from extra-abdominal tumors is thought to be rare. Lung cancer is one of the most common cancers in the world with early metastases and it is associated with poor prognosis in advanced stages. Peritoneal metastases from lung cancer are uncommon and the real mechanism of its diffusion to the peritoneum is unknown. However, its clinical behavior is similar to any other peritoneal metastasis from abdominal tumors.

CASE PRESENTATION

We present two Caucasian patients (a 44-year-old man and a 59-year-old man) with bowel obstruction from peritoneal metastases from non-small cell lung cancer who successfully underwent emergency cytoreductive surgery and had a good prognosis and survival.

CONCLUSIONS

In our patients with isolated peritoneal metastases from lung cancer, cytoreduction showed good prognosis with acceptable morbidity. This treatment option might be considered in highly selected cases to improve survival. Strict follow-up is mandatory to allow early diagnosis of peritoneal diffusion.

Pathological diagnosis and treatment outcome of gastric metastases from small cell lung cancer: A case report

Small cell lung cancer (SCLC) is a type of lung cancer characterized by a rapid disease progression and poor prognosis. Its diagnosis is often accompanied by distant metastasis. A literature review revealed that metastases to the stomach from breast, lung and esophageal cancer are frequently reported. While SCLC is a common pathological subtype of lung cancer, literature on SCLC with gastric metastases is sporadic. The present study reviewed the literature using databases, including PubMed, WanFang Data and China National Knowledge Infrastructure, to analyze the clinicopathological features and outcome of patients with gastric metastases from SCLC. A total of 11 case reports and 6 retrospective studies comprising of 19 cases were compared and analyzed. In addition to the aforementioned studies, a case study describing a patient who survived for 10 months following a diagnosis of SCLC with gastric metastases is presented. The aim of the present study was to increase the understanding regarding the diagnosis and treatment of SCLC gastric metastasis.

Bowel obstruction caused by colonic metastasis of lung adenocarcinoma: a case report and literature review

Introduction

Lung cancer is the most common cause of cancer-related deaths globally. Metastatic disease is often found at the time of initial diagnosis in the majority of lung cancer patients. However, colonic metastases are rare. This report describes an uncommon case of colonic metastasis from lung adenocarcinoma.

Case presentation

A 64-year-old female presented to her gastroenterologist for progressively worsening abdominal pain and constipation. Exploratory colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. Her specialist recommended she immediately go to her regional hospital for further workup. On admission, she complained of continued abdominal pain and constipation. Notably, she had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed 1 year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. Upon hospital admission, she underwent an urgent colostomy, ileocecectomy and anastomosis, and rectosigmoid mass resection with tissue sampling. Pathology confirmed the diagnosis of colonic metastasis from primary lung adenocarcinoma. Treatment was with systemic chemotherapy followed by localized radiation to the pelvic region was started. She did not respond well to these therapies. Subsequent imaging showed refractory tumor growth in the pelvic region. Treatment could not be completed due to the patient experiencing a debilitating stroke, and she was transitioned to hospice care.

Conclusions

Clinicians should have a low threshold for intestinal investigation and considerations for colonic metastasis when patients with a history of primary lung cancer have abdominal symptoms.

Colonic Metastasis of Lung Adenocarcinoma: A Case Report

Colonic metastases are extremely rare, regardless of primary lung cancer type. A 64-year-old female was referred to the hospital by her gastroenterologist after a same-day colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. On admission, she complained of abdominal pain and constipation. She had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed one year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. She underwent urgent surgical intervention and mass resection with tissue sampling. Pathology confirmed the diagnosis of metastatic lung adenocarcinoma. Systemic chemotherapy with pemetrexed and carboplatin followed by localized radiation to the pelvic region was administered. A refractory pelvic region tumor growth was evident on subsequent imaging. Cessation of chemoradiation therapy occurred after the patient experienced a debilitating stroke and she was transferred to hospice care. Colonic metastasis should be considered when patients with a history of primary lung cancer have abdominal symptoms.

Small bowel perforation with multiple intestinal metastases from lung carcinoma: A case report

The present report describes the case of an 81-year-old woman who underwent an emergency explorative laparotomy due to small bowel perforation. Diffuse feculent peritonitis due to perforation of the jejunum was identified. In addition, six distinct tumors of the jejunum in close proximity to the perforation site, as well as two more lesions caudally at the ileum, were identified. A separate stenotic tumor was identified at the sigmoid colon, causing moderate dilatation of the whole intestine. An enterectomy, including the perforation site and the proximal six tumors, was performed, followed by limited enterectomies for the distal two tumors and side-to-side anastomoses of the small intestine. All resected tumors were identified at histology as metastatic from lung carcinoma. Postoperatively, the patient remained in a severe septic condition and succumbed the following day. Metastatic lesions from lung carcinoma in the small bowel wall are a rare finding predisposing to bowel perforation. When an acute condition coexists with multiple intestinal metastases, the mortality rate is high despite prompt surgical intervention.

Perforation of small intestine secondary to metastatic lung adenocarcinoma: A case report

RATIONALE

About 50% of patients with a diagnosis of nonsmall cell lung carcinoma exhibit metastatic disease at the time of diagnosis. The preferential sites of extrapulmonary spread are the lymph nodes, liver, brain, adrenal glands, and bones; gastrointestinal tract perforation secondary to metastatic lung cancer is extremely rare.

PATIENT CONCERNS

A 60-year-old male nonsmoker patient presented with a 20-day history of facial, neck, and right upper limb edema. Physical examination revealed a 3.5 cm mass in his right chest. Computed tomography (CT) revealed a 4 cm mass near the right lung hilum.

DIAGNOSIS

Biopsy of the right chest wall mass revealed low differentiated lung adenocarcinoma. Additionally, retroperitoneal lymphadenopathy, pericardial effusion, metastases in the mediastinum, bilateral adrenal gland, and right thoracic wall nodule, as well as multiple bone metastases were also found.

INTERVENTIONS

Since the patient was diagnosed with multiple metastatic lung cancer, chemotherapy was started. One week after chemotherapy, he experienced a sudden acute abdominal pain. Abdominal CT examination indicated the possibility of intestinal perforation. Hence, the patient underwent an emergency operation. During the surgical procedure, 2 perforations of size 1×1 cm were discovered at 110 cm and 140 cm of the jejunum from Treitz's ligament. Then, an intestinal resection and end-to-end anastomosis were performed. The pathological diagnosis of the resected specimen revealed that it was a metastatic lung adenocarcinoma of small intestine.

OUTCOMES

The patient died 10 days after operation and 19 days following the cancer diagnosis due to septic shock.

LESSONS

Gastrointestinal tract metastasis from the lung is uncommon, but the survival rate is extremely low; therefore, it should be considered as a possibility in patients who present with any of the gastrointestinal symptoms.

Intestinal metastasis from primary ROS1-positive lung adenocarcinoma cancer patients responding to crizotinib

Small intestinal metastases from primary lung cancer are rare. Such patients have a poor prognosis. Early diagnosis of small intestinal metastases is difficult because of the low incidence of clinically apparent symptoms. The standard treatment for small intestinal metastases has not been established. A 69-year-old Chinese man presented for evaluation of a tumor in the right lower lung and mediastinal lymph node enlargement on clinical examination. The clinical stage was cT₂N₂M₀ (stage IIIA). Histologic examination of the tumor revealed lung adenocarcinoma. He could not tolerate surgery; hence, he received two chemotherapy regimens. However, the disease progressed. He had bloating after chemotherapy and decreased flatus. An abdominal CT scan showed an intestinal effusion with local intestinal obstruction. Medical treatment was ineffective; hence, he underwent a diagnostic laparoscopy. The pathologic evaluation suggested an intestinal metastatic adenocarcinoma from the primary lung cancer. Based on an real-time PCR assay, the tumor had a ROS1 fusion and responded well to crizotinib. The progression-free survival was 7 months. Physicians must be aware of the possibility of intestinal metastases from primary lung cancer. With an accurate diagnosis and thorough evaluation, patients may benefit from targeted therapy.

Isolated colonic metastasis two years after resection of stage IA primary adenocarcinoma of the lung: A case report

Colonic metastasis from lung cancer is rare, generally asymptomatic and usually develop at advanced cancer stages. Here, we report a case with a resected stage IA lung adenocarcinoma in a 51yo male patient that presented two years later with mild abdominal pain due to intestinal obstruction caused by a metastatic colon tumor. The patient underwent colonoscopy followed by surgical resection and the pathologic report was adenocarcinoma which was the same as that from a lung nodule that was excised two years earlier. Immunohistochemistry was cytokeratin 7 (CK7) positive, thyroid transcription factor 1 (TTF1) focally positive and cytokeratin 20 (CK20), caudal-related homeobox transcription factor 2 (CDX2) negative on both lung biopsy and colon surgical specimens. Interestingly there was no obvious lung cancer recurrence both at the time of metastasis and one year following chemotherapy.