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Lin ZX, Weiss A, Lee KI, Heering G, Chang L, Pais S. Metastatic Squamous Cell Carcinoma of the Lung Disclosed From Constipation Workup. ACG Case Rep J 2023; 10:e01133. [PMID: 37654618 PMCID: PMC10468112 DOI: 10.14309/crj.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
A palpable rectal mass associated with gastrointestinal (GI) symptoms immediately raises concern for colorectal cancer, but rarely can represent distant metastatic disease. The incidence of symptomatic colorectal metastasis from a primary lung cancer without any pulmonary symptom is extremely rare. We report a rare case of constipation as the presenting symptom in a patient ultimately found to have metastatic squamous cell carcinoma of the lung. A rectal mass was readily palpable on examination, illustrating the importance of digital rectal examination. In addition, GI clinicians should maintain a high index of suspicion when evaluating patients at risk of non-GI malignancies.
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Affiliation(s)
- Zilan X. Lin
- Division of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, Valhalla, NY
- Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Aaron Weiss
- Division of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, Valhalla, NY
| | - Kyu-In Lee
- Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Gabriel Heering
- Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Lillian Chang
- Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Shireen Pais
- Division of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, Valhalla, NY
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2
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Severin S, Terrones Munoz V, Meert N, Peche R. [Duodenal bleeding due to metastasis from lung adenocarcinoma controlled by radiotherapy: A case report and literature review]. Rev Mal Respir 2023; 40:359-365. [PMID: 36868976 DOI: 10.1016/j.rmr.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
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.
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Affiliation(s)
- S Severin
- Département de Médecine Interne, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgique.
| | - V Terrones Munoz
- Service de Pneumologie, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgique
| | - N Meert
- Service de Radiothérapie, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgique
| | - R Peche
- Service de Pneumologie, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgique
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3
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Sautto F, Tinsley S, Neychev V. Small Bowel Perforation Due to Rare Metastasis From Stage IV Lung Adenocarcinoma. Cureus 2022; 14:e29551. [PMID: 36312691 PMCID: PMC9595031 DOI: 10.7759/cureus.29551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
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.
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Gandhi M, Chela HK, Ertugrul H, Al Juboori A, Gangu K, Rao D, Daglilar E. A Case Series of Gastric Metastatic Growths. Diseases 2022; 10:diseases10030061. [PMID: 36135217 PMCID: PMC9498294 DOI: 10.3390/diseases10030061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Gastric cancer is one of the gastrointestinal malignancies that can be quite devastating with high morbidity and mortality. Unfortunately, it is a malignancy that is encountered all across the world and is often brought into suspicion based on symptoms of the patient. The presentation differs based on the symptomatology and can be quite variable in each and every case. Malignant lesions in the stomach discovered endoscopically can represent as primary gastric growths or can be secondary as a consequence of metastatic spread from a distant primary site. It is important to recognize the different patterns of presentation of metastatic disease and to be aware of the primary tumor sites. The treatment and ultimately the prognosis changes drastically when dealing with a metastatic disease as opposed to a primary localized source with limited spread. The aim of our study is to present a mini series of cases that manifest as metastatic gastric growths. Their clinical, endoscopic and histological appearance is depicted to provide an understanding of each case. The primary sites of origin for our patients were the lungs, skin, lymphoid tissue and kidneys. Their overall clinical course is presented including the approach to the management in each case as well as their outcomes.
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Affiliation(s)
- Mustafa Gandhi
- Department of Medicine, University of Missouri, Columbia, MO 65201, USA
| | - Harleen Kaur Chela
- Department of Gastroenterology, University of Missouri, Columbia, MO 65201, USA
- Correspondence:
| | - Hamza Ertugrul
- Department of Gastroenterology, University of Missouri, Columbia, MO 65201, USA
| | - Alhareth Al Juboori
- Department of Gastroenterology, University of Missouri, Columbia, MO 65201, USA
| | - Karthik Gangu
- Department of Medicine, Division of Hospital Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Deepthi Rao
- Department of Pathology, University of Missouri, Columbia, MO 65201, USA
| | - Ebubekir Daglilar
- Department of Gastroenterology, University of West Virginia, Charleston, WV 25304, USA
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5
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Catalano M, Marini A, Ferrari K, Voltolini L, Cianchi F, Comin CE, Castiglione F, Roviello G, Mini E. Gastric and colonic metastasis from NSCLC: A very unusual case report. Medicine (Baltimore) 2022; 101:e28249. [PMID: 35029172 PMCID: PMC8758018 DOI: 10.1097/md.0000000000028249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Lung cancer is the most common cause of cancer-related deaths worldwide. Approximately 50% of patients is metastatic at diagnosis and the most common metastatic sites are bone, lungs, brain, adrenal glands, liver, and extra thoracic lymph nodes. The occurrence of gastrointestinal metastasis from lung carcinoma is rare and seems more commonly related to small cell lung cancer compared to non-small cell lung cancer (NSCLC). PATIENT INFORMATION AND DIAGNOSIS A 78-year-old man with completely surgically resected NSCLC and no initial evidence of distant metastases developed colon and gastric metastases 7 months after diagnosis, confirmed by serial radiological examinations and endoscopic biopsies. INTERVENTIONS The patient was subjected to total gastrectomy with D2 lymph node dissection plus partial colectomy for intraoperative detection of a transverse colon neoformation. Subsequent instrumental imaging showed bilateral lung tumor recurrence, treated with gemcitabine monotherapy for 8 months as first line chemotherapy for lung adenocarcinoma. RESULTS The patient presented complete response to therapy and was disease-free for 4 years. LESSONS Colonic and gastric metastasis are very infrequent in NSCLC. The resection of gastrointestinal metastasis may provide benefits in terms of both symptom control and survival in patients properly selected.
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Affiliation(s)
- Martina Catalano
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Andrea Marini
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Katia Ferrari
- Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, Florence, Italy
| | - Fabio Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Camilla Eva Comin
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Francesca Castiglione
- Histopathology and Molecular Diagnostics Unit, Careggi University Hospital, Florence, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, VialePieraccini, 6, Florence, Italy
| | - Enrico Mini
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, VialePieraccini, 6, Florence, Italy
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Dabek RJ, Bizanti A, Thomas S, Kalla A, Hamdallah I. Squamous Cell Carcinoma of the Tonsil Causing Small Bowel Perforation in the Setting of Metastasis and Treatment With Programmed Death-1 Inhibitors: A Case Report. Cureus 2020; 12:e10739. [PMID: 33029471 PMCID: PMC7529493 DOI: 10.7759/cureus.10739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Metastasis of extra-intestinal carcinoma to the gastrointestinal tract (GIT) is a rare event, most commonly occurring with malignant melanoma. Anti-PD-1 (programmed death-1) immunotherapeutic agents are immune checkpoint inhibitors with proven benefit across multiple cancer types, including squamous cell carcinoma of the head and neck (SCCHN). Here we describe a case of small bowel perforation attributed to a primary SCCHN metastasizing to the GIT in the setting of treatment with PD-1 inhibitors.
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Affiliation(s)
- Robert J Dabek
- Department of Surgery, Saint Agnes Hospital, Baltimore, USA
| | - Anas Bizanti
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, USA
| | | | - Abhishek Kalla
- Department of Hematology and Oncology, Saint Agnes Hospital, Baltimore, USA
| | - Isam Hamdallah
- Department of Surgery, Saint Agnes Hospital, Baltimore, USA
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7
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Maeda Y, Shinohara T, Minagawa N, Kobayashi T, Koyama R, Shimada S, Tsunetoshi Y, Murayama K, Hasegawa H. A retrospective analysis of emergency surgery for cases of acute abdomen during cancer chemotherapy. Case series. Ann Med Surg (Lond) 2020; 57:143-147. [PMID: 32760583 PMCID: PMC7393459 DOI: 10.1016/j.amsu.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background Treatment for acute abdomen during chemotherapy is frequently difficult because of the complicated status of the patients, and there have been only a few case series summarizing the outcomes of emergent surgery during chemotherapy. The aim of this study was to clarify the clinical outcomes of emergency surgery for acute abdomen during chemotherapy and identify predictive factors associated with mortality. Methods We retrospectively analyzed the records of patients who underwent emergency surgery for acute abdomen within 30-days after anti-cancer drugs administration between 2009 and 2020. Results Thirty patients were identified. The primary malignancies were hematological (n = 7), colorectal (n = 4), lung (n = 4), stomach (n = 2), breast (n = 2), prostate (n = 2) and others (n = 5). Fifteen patients were treated with the regimen, including molecular-targeted anti-cancer drugs (Bevacizumab: 8 cases, Rituximab: 4, Ramucirumab: 2, and Gefitinib: 1). Indications for emergency surgery were perforation of the gastrointestinal tract (n = 24), appendicitis (n = 3), bowel obstruction (n = 2), and gallbladder perforation (n = 1). Severe morbidity (Clavien-Dindo IIIa or more) occurred in 8 cases (27%), and there were 6 in-hospital deaths (20%). Significant factors related to in-hospital death were age >70 years old (P = 0.029), poor performance status (ECOG score 1 or 2) (P = 0.0088), and serum albumin level <2.6 g/dl (P = 0.026). The incidence of acute abdomen (odds ratio 5.31, P = 0.00017) was significantly higher in the patients receiving anti-VEGF drugs than in those without anti-VEGF drugs. Conclusion This study identified three predictive factors associated with in-hospital death after emergency surgery during chemotherapy: an older age, poor performance status, and low serum albumin level.
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Affiliation(s)
- Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | | | - Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Shingo Shimada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Yusuke Tsunetoshi
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Keisuke Murayama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Haruka Hasegawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
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8
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[Hemoglobin drop after thrombolytic therapy in a 57-year-old stroke patient with "erosive gastritis"]. Internist (Berl) 2020; 61:746-753. [PMID: 32533196 DOI: 10.1007/s00108-020-00818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 57-year-old woman underwent esophagogastroduodenoscopy due to a continuous drop in hemoglobin levels reaching 7.4 g/dl after treatment with intravenous thrombolytic therapy 1 week earlier because of an ischemic insult. Numerous erosive lesions were found in the gastric corpus. Histological staining of a specimen from the gastric lesions revealed a poorly differentiated adenocarcinoma. Immunohistochemical examination confirmed the diagnosis of gastric metastasis from lung cancer based on positive staining for thyroid transcriptional factor‑1 (TTF-1) and cytokeratin 7 (CK7) as well as via negative staining for caudal-type homeobox‑2 (CDX-2). Chest computed tomography demonstrated a mediastinal mass, measuring 3.2 cm and involving the cervical and supraclavicular lymph nodes. A lymph node was subsequently extirpated. Immunohistochemical examination confirmed the diagnosis of lymph node metastasis from lung cancer by positive staining for TTF‑1 and CK7. Symptomatic gastric metastasis from lung cancer is an extremely rare clinical entity. Transesophageal echocardiography detected a mass measuring 1.6 cm at the mitral valve with pericardial effusion. On the basis of the echocardiographic findings, a malignant origin was suggested after exclusion of infectious endocarditis. We assumed that the multiple organ infarctions (spleen, kidney, and brain) and gastric hematogenous metastasis must have been caused by disseminated arterial tumor embolism from the intracardiac metastasis. The patient was treated palliatively and died.
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9
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Tanriverdi O, Alkan A, Ozseker B, Solak-Ozseker H, Kilinc RM. Synchronous duodenum and descending colon metastasis from primary lung neuroendocrine small-cell carcinoma: A case report and review of the literature. J Oncol Pharm Pract 2020; 26:1524-1529. [PMID: 32063106 DOI: 10.1177/1078155220904133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Metastasis to the gastrointestinal tract from lung cancer is very uncommon and is often asymptomatic. Although small bowel metastasis may commonly occur, metastases to the stomach and colon are uncommon. CASE REPORT In this paper, we present a previously healthy 57-year-old male patient, a 60-packet per year smoker, who was taken to the emergency room with complaints of increasing abdominal pain, rectal bleeding, weight loss, and dyspnea for the last three months. Endoscopic examination revealed polypoid lesions in the duodenum and the descending colon. We diagnosed neuroendocrine small-cell lung cancer based on histopathological and immunohistochemical staining.Management and outcome: A cisplatin (d1, 60 mg/m2/day)-etoposide (d1 to d3, 120 mg/m2/day) regimen was given every three weeks as palliative chemotherapy. After the three course of chemotherapy, the lung radiograph showed a decline in hilar expansion and there was no pleural effusion. Then, he died of acute respiratory failure two weeks after radiotherapy of brain. DISCUSSION Gastrointestinal tract metastasis of lung cancer is recognized synchronously with or rarely before diagnosis. It is generally recognized after the diagnosis of lung cancer. These patients often have other concurrent body metastases. Prognosis is poor, and survival expectation is short. The most common metastases to the gastrointestinal tract are squamous and large cell lung cancer metastases. Our aim is to emphasize the importance of immunohistochemical examination for masses in the gastrointestinal tract and to present this rare case of synchronous duodenal and colonic metastases of small-cell lung cancer.
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Affiliation(s)
- Ozgur Tanriverdi
- Department of Medical Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Ali Alkan
- Department of Medical Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Burak Ozseker
- Department of Gastroenterology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Havva Solak-Ozseker
- Department of Medical Pathology, Mugla Sitki Kocman University Education and Research Hospital, Mugla, Turkey
| | - Rabia Mihriban Kilinc
- Department of Radiodiagnostics, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
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10
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Clinical Characteristics and Prognosis of Gastrointestinal Metastases in Solid Tumor Patients: A Retrospective Study and Review of Literatures. Anal Cell Pathol (Amst) 2019; 2019:4508756. [PMID: 31929965 PMCID: PMC6939450 DOI: 10.1155/2019/4508756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/18/2019] [Indexed: 01/11/2023] Open
Abstract
Background According to the literature and our experience, patients with gastrointestinal metastases are relatively rare. Numerous case reports and literature reviews have been reported. We present one of the larger case series of gastrointestinal metastases. Objectives To explore the clinical characteristics and prognosis of patients with gastrointestinal tract metastases, which are rare metastatic sites. Methods Patients with gastrointestinal metastases in the setting of stage IV primary carcinomas treated at Beijing Ditan Hospital and Peking University International Hospital from November 1992 to August 2017 were included in this study. The diagnosis of gastrointestinal tract metastases was based on histopathology. Results 30 patients (median age 56 years, 56.7% female) were included. The most common primary carcinomas associated with gastrointestinal metastases were breast (11 patients, 36.7%), stomach (9 patients, 30.0%), and lung (4 patients, 13.3%) cancer. The major pathological types were adenocarcinoma (16 patients, 53.3%) and ductal carcinoma (9 patients, 30.0%). Ten patients (33.3%) underwent local gastrointestinal treatment, and 20 patients (66.7%) underwent nonlocal treatment (involving chemotherapy alone or best supportive care). For breast cancer patients and gastric cancer patients who underwent local therapy, a significant survival advantage was observed (p = 0.001 and p = 0.012, respectively). The presence of other common metastases was identified as an independent poor prognostic factor through multivariate analysis with a HR (hazard ratio) of survival of 0.182 (95% confidence interval (CI) 0.11-0.523, p = 0.031). Conclusion Gastrointestinal metastases are most frequently from breast invasive ductal carcinoma. The presentation of other common metastases with gastrointestinal metastasis indicates poor prognosis, and selected patients may benefit from surgical intervention.
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11
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Sato S, Senmaru N, Ishido K, Saito T, Poudel S, Muto J, Syouji Y, Hase R, Hirano S. Perforation of small intestinal metastasis of lung adenocarcinoma treated with pembrolizumab: a case report. Surg Case Rep 2019; 5:166. [PMID: 31667679 PMCID: PMC6821905 DOI: 10.1186/s40792-019-0730-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background Pembrolizumab is an immune checkpoint inhibitor and is an anti-human programmed cell death-1 (PD-1) monoclonal antibody. Pembrolizumab is used for non-small cell lung carcinoma with high programmed cell death ligand-1 (PD-L1) expression. It has been found that better overall survival can be obtained using pembrolizumab compared to the existing chemotherapy. We report a case of perforation of small intestinal metastasis after pembrolizumab treatment. Case presentation A 62-year-old man was treated by pembrolizumab for PD-L1 highly expressed lung adenocarcinoma, with multiple metastasis (small intestinal, lymph nodes, and bone). The treatment was stopped owing to drug-induced pneumonitis. One month after drug withdrawal, the patient visited the emergency department of our hospital with the complaint of severe stomachache. He had a rigid abdomen and generalized tenderness, and computed tomography scans showed free air within the abdomen. We diagnosed bowel perforation and performed emergency surgery. Surgical findings revealed multiple small intestine metastasis and mesenteric lymph node metastasis. Perforation was found in the metastatic site in the jejunum located around 40 cm anal to Treitz’s ligament. This perforated part was resected, and functional end-to-end anastomosis was performed using linear staplers. The post-operative course was uneventful. Pathological examination revealed lung adenocarcinoma metastasis at the perforation site, and the effectiveness of pembrolizumab was grade 1b (Japanese Classification of the Colorectal Carcinoma, seventh edition). Conclusions This is the first report of perforation of small intestinal metastasis of lung adenocarcinoma after pembrolizumab treatment. Because pembrolizumab causes some side effects, particularly autoimmune side effects, careful attention during treatment is warranted.
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Affiliation(s)
- Shoki Sato
- Department of Surgery, Steel Memorial Muroran Hospital, 1-45, Chiribetu-chou, Muroran, Hokkaido, 050-0046, Japan. .,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, N-15 W-7, Sapporo, Hokkaido, 060-8638, Japan.
| | - Naoto Senmaru
- Department of Surgery, Steel Memorial Muroran Hospital, 1-45, Chiribetu-chou, Muroran, Hokkaido, 050-0046, Japan
| | - Keita Ishido
- Department of Surgery, Steel Memorial Muroran Hospital, 1-45, Chiribetu-chou, Muroran, Hokkaido, 050-0046, Japan
| | - Takahiro Saito
- Department of Surgery, Steel Memorial Muroran Hospital, 1-45, Chiribetu-chou, Muroran, Hokkaido, 050-0046, Japan
| | - Saseem Poudel
- Department of Surgery, Steel Memorial Muroran Hospital, 1-45, Chiribetu-chou, Muroran, Hokkaido, 050-0046, Japan
| | - Jun Muto
- Department of Surgery, Steel Memorial Muroran Hospital, 1-45, Chiribetu-chou, Muroran, Hokkaido, 050-0046, Japan
| | - Yasuhito Syouji
- Department of Surgery, Steel Memorial Muroran Hospital, 1-45, Chiribetu-chou, Muroran, Hokkaido, 050-0046, Japan
| | - Ryunosuke Hase
- Department of Surgery, Steel Memorial Muroran Hospital, 1-45, Chiribetu-chou, Muroran, Hokkaido, 050-0046, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, N-15 W-7, Sapporo, Hokkaido, 060-8638, Japan
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12
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Upper Gastrointestinal Bleed due to Duodenal Metastases of Lung Adenocarcinoma: Report of Two Cases and Review of Literature. Case Rep Med 2019; 2019:3437056. [PMID: 31772583 PMCID: PMC6854212 DOI: 10.1155/2019/3437056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022] Open
Abstract
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.
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13
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Misiakos EP, Gouloumi AR, Schizas D, Damaskou V, Tsapralis D, Farrugia FA, Machairas N, Papaconstantinou D, Tzaneti A, Machairas A. Small bowel perforation with multiple intestinal metastases from lung carcinoma: A case report. Oncol Lett 2019; 17:3862-3866. [PMID: 30881505 PMCID: PMC6403519 DOI: 10.3892/ol.2019.10031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/23/2019] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Evangelos P Misiakos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens 12462, Greece
| | - Alina-Roxani Gouloumi
- 2nd Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens 12462, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Laiko Hospital, Athens 11527, Greece
| | - Vasileia Damaskou
- 2nd Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens 12462, Greece
| | - Dimitrios Tsapralis
- Department of General Surgery, General Hospital/Health Center of Ierapetra, Crete 77200, Greece
| | - Frederick-Anthony Farrugia
- 3rd Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens 12462, Greece
| | - Nikolaos Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens 12462, Greece
| | - Dimitrios Papaconstantinou
- 3rd Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens 12462, Greece
| | - Ariadni Tzaneti
- 3rd Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens 12462, Greece
| | - Anastasios Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens 12462, Greece
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Wang J, Chen Y, Zhang S, Chen Q. Perforation of small intestine secondary to metastatic lung adenocarcinoma: A case report. Medicine (Baltimore) 2018; 97:e13469. [PMID: 30544434 PMCID: PMC6310494 DOI: 10.1097/md.0000000000013469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Jian Wang
- Department of The Third General Surgery, People's Hospital of Xiangzhou, Xiangyang City
| | - Yimeng Chen
- Grade 2015, 8 Years of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Sisi Zhang
- Department of Emergency Surgery, Union Hospital
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15
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Isolated colonic metastasis two years after resection of stage IA primary adenocarcinoma of the lung: A case report. Respir Med Case Rep 2018; 25:86-88. [PMID: 30094153 PMCID: PMC6076219 DOI: 10.1016/j.rmcr.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 02/07/2023] Open
Abstract
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.
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16
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Garavello A, Fransvea P, Rossi S, Giacovazzo F, Marino V. Bowel perforation secondary to metastatic lung cancer: Report of two cases with literature review. Int J Surg Case Rep 2018; 51:331-334. [PMID: 30245356 PMCID: PMC6153395 DOI: 10.1016/j.ijscr.2018.07.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/16/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023] Open
Abstract
Intestinal metastasis of a pulmonary tumor is a rare occurrence but must be suspected in acute abdominal syndrome in a patient with a diagnosed pulmonary neoplasia. Emergency surgical treatment of abdominal metastases of a lung cancer is mandatory but prognosis is extremely unfavorable.
Introduction Gastrointestinal metastases from pulmonary neoplasm represent a rare but potentially fatal pathology that can complicate the disease in most advanced stages; this is a rare but well-known phenomenon in Literature and small intestine is the most common metastatic site. Generally these are patients with a known or surgically treated pulmonary neoplasm; the onset of pulmonary neoplastic disease with a symptomatic intestinal metastasis is to be considered extremely rare. Presentation of cases We report two cases of small intestine perforation from pulmonary metastasis; diagnosis was made at the time of exploratory laparotomy and the operation was in one patient the resection of the perforated bowel and in the second a resection and an intestinal bypass to overcome the stenosis caused by the metastatic masses. In the postoperative period, a patient died of pulmonary complications, the second was dismissed, but survival was only three months. Discussion Intestinal metastasis of a pulmonary tumor is a rare occurrence but must be suspected in acute abdominal syndrome in a patient with a diagnosed pulmonary neoplasia. Conclusion Emergency surgical treatment of abdominal metastases of a lung cancer is mandatory but prognosis is extremely unfavorable.
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Affiliation(s)
- Alberto Garavello
- Emergency Surgery and Trauma Care Unit, St. Filippo Neri's Hospital, Rome, Italy
| | - Pietro Fransvea
- Faculty of Medicine and Psychology, "Sapienza" University of Rome, St. Andrea's Hospital, Italy.
| | - Stefano Rossi
- Faculty of Medicine and Psychology, "Sapienza" University of Rome, St. Andrea's Hospital, Italy
| | - Francesco Giacovazzo
- Faculty of Medicine and Psychology, "Sapienza" University of Rome, St. Andrea's Hospital, Italy
| | - Vincenza Marino
- Department of Radiology, St. Filippo Neri's Hospital, Rome, Italy
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17
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Balla A, Subiela JD, Bollo J, Martínez C, Rodriguez Luppi C, Hernández P, Pascual-González Y, Quaresima S, Targarona EM. Gastrointestinal metastasis from primary lung cancer. Case series and systematic literature review. Cir Esp 2018; 96:184-197. [PMID: 29567360 DOI: 10.1016/j.ciresp.2017.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/14/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
Aim of the present study is to report clinical characteristics and outcomes of patients treated in authors' hospital for GI metastasis from primary lung cancer, and to report and analyse the same data concerning patients retrieved from a systematic literature review. We performed a retrospective analysis of prospectively collected data, and a systematic review using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Ninety-one patients were included, 5 patients from the authors' hospital and 86 through PubMed database using the keywords "intestinal metastasis" AND "lung cancer". The median time between primary lung cancer diagnosis and GI metastasis diagnosis was 2 months and the median overall survival was 4 months. This group of patients present a poor prognosis and the gold standard treatment is not defined. None of the reported treatments had a significant impact on survival.
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Affiliation(s)
- Andrea Balla
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España; Department of General Surgery and Surgical Specialties Paride Stefanini, Sapienza, University of Rome, Roma, Italia.
| | - José D Subiela
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Jesús Bollo
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Carmen Martínez
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Carlos Rodriguez Luppi
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Pilar Hernández
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Yuliana Pascual-González
- Servicio de Neumología, Hospital Universitario de Bellvitge, Universidad de Barcelona, Barcelona, España
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties Paride Stefanini, Sapienza, University of Rome, Roma, Italia
| | - Eduard M Targarona
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
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18
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Taira N, Kawabata T, Gabe A, Furugen T, Ichi T, Kushi K, Yohena T, Kawasaki H, Higuchi D, Chibana K, Fujita K, Nakamoto A, Owan I, Kuba M, Ishikawa K. Analysis of gastrointestinal metastasis of primary lung cancer: Clinical characteristics and prognosis. Oncol Lett 2017; 14:2399-2404. [PMID: 28781676 DOI: 10.3892/ol.2017.6382] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/03/2017] [Indexed: 01/19/2023] Open
Abstract
The prevalence of gastrointestinal metastasis of lung cancer is low. The aim of the present study was to analyze the frequency and clinical characteristics of metastases to the gastrointestinal tract by retrospectively assessing the clinical records of 2,066 patients with lung cancer. A total of 7 patients (0.33%) were diagnosed with gastrointestinal metastasis, including 4 patients with adenocarcinoma, 1 patient with large cell carcinoma and 2 patients with pleomorphic carcinoma. Furthermore, 3 of the patients presented with small bowel metastases, 2 with gastric metastases, 1 with large bowel metastasis and 1 with metastasis of the appendix. The mean time between the diagnosis of the lung tumors and the identification of gastrointestinal metastasis was 13.5 months (range, 3-49 months). The mean time between the identification of the gastrointestinal metastasis and mortality was 100.6 days (range, 21-145 days). In conclusion, the prognosis of patients with recurrence in distant organs, including the gastrointestinal tract, may be worse than patients with recurrence in distant organs, excluding the gastrointestinal tract, particularly those with symptomatic gastrointestinal metastasis. Therefore, the presence of clinical gastrointestinal metastasis may be life threatening; comprehensive evaluations are required to detect and monitor gastrointestinal metastasis during follow-up.
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Affiliation(s)
- Naohiro Taira
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Tsutomu Kawabata
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Atsushi Gabe
- Department of General Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Haebaru, Okinawa 9011193, Japan
| | - Tomonori Furugen
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Takaharu Ichi
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kazuaki Kushi
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Tomofumi Yohena
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Hidenori Kawasaki
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Daisuke Higuchi
- Department of Gastroenterology, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kenji Chibana
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kaori Fujita
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Atsushi Nakamoto
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Isoko Owan
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Mutsuo Kuba
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kiyoshi Ishikawa
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
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19
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Gastric Metastases from Lung Adenocarcinoma Causing Gastrointestinal Bleeding. ACG Case Rep J 2017; 4:e25. [PMID: 28286791 PMCID: PMC5340659 DOI: 10.14309/crj.2017.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/08/2016] [Indexed: 12/16/2022] Open
Abstract
Metastases to the stomach are rare. They are commonly asymptomatic, and the diagnosis is usually established during autopsy. We present a patient known to have stage IV lung adenocarcinoma who presented with melena and shock. Endoscopy revealed multiple gastric nodules, which were proved to be metastatic deposits from her lung cancer. The possibility of gastric metastases should be kept in mind in patients presenting with gastrointestinal bleeding. Endoscopy and biopsy remain the gold standard for diagnostic testing in such patients.
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20
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Obstrucción intestinal por metástasis de cáncer de pulmón. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:466-8. [DOI: 10.1016/j.gastrohep.2015.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 06/17/2015] [Indexed: 11/20/2022]
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21
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Linsen PVM, Linsen VMJ, Buunk G, Arnold DE, Aerts JGJV. Iron deficiency anemia as initial presentation of a non-small cell lung carcinoma: A case report. Respir Med Case Rep 2015; 16:109-11. [PMID: 26744672 PMCID: PMC4681980 DOI: 10.1016/j.rmcr.2015.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 02/07/2023] Open
Abstract
Duodenal metastases secondary to lung cancer are very rare and most of the time asymptomatic. When symptomatic they usually present with bowel obstruction or perforation. We here describe the case of a 68 year-old man with a solitary metastasis in the duodenum from a non-small cell lung carcinoma (NSCLC). The patient presented with reduced exercise tolerance and iron deficiency anemia without clinical gastrointestinal blood loss. Further investigation showed a tumor in the left upper lung lobe and a duodenal metastasis for which he received chemotherapy. To the best of our knowledge this is the first case report of iron deficiency anemia as initial presentation of a duodenal metastasis from a NSCLC.
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Affiliation(s)
| | | | - Gerba Buunk
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | | | - Joachim G J V Aerts
- Department of Pulmonology, Amphia Hospital, Breda, The Netherlands; Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
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22
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Park JY, Hong SW, Lee JY, Kim JH, Kang JW, Lee HW, Im JP. Simultaneous Esophageal and Gastric Metastases from Lung Cancer. Clin Endosc 2015; 48:332-5. [PMID: 26240809 PMCID: PMC4522427 DOI: 10.5946/ce.2015.48.4.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/10/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022] Open
Abstract
We report of a patient with metastatic adenocarcinoma of the esophagus and stomach from lung cancer. The patient was a 68-year-old man receiving radiotherapy and chemotherapy for stage IV lung cancer, without metastases to the gastrointestinal (GI) tract at the time of the initial diagnosis. During the treatment period, dysphagia and melena newly developed. Upper GI endoscopy revealed geographic erosion at the distal esophagus and multiple volcano-shaped ulcers on the stomach body. Endoscopic biopsy was performed for each lesion. To determine whether the lesions were primary esophageal and gastric cancer masses or metastases from the lung cancer, histopathological testing including immunohistochemical staining was performed, and metastasis from lung cancer was confirmed. The disease progressed despite chemotherapy, and the patient died 5 months after the diagnosis of lung cancer. This is a case report of metastatic adenocarcinoma in the esophagus and stomach, which are very rare sites of spread for lung cancer.
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Affiliation(s)
- Jae Yong Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Wook Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Woo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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23
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Alkabie S, Bello B, Martinez RF, Geis WP, Ballo MS. Metastatic Adenocarcinoma of Unknown Origin Presenting as Small Bowel Perforation. J Investig Med High Impact Case Rep 2015; 3:2324709615577415. [PMID: 26425638 PMCID: PMC4586912 DOI: 10.1177/2324709615577415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Metastatic malignant tumors that originate from occult primaries are defined as “cancers of unknown origin.” We herein present the case of a 59-year-old man who presented with small bowel perforation secondary to metastatic adenocarcinoma of an unknown primary site. Imaging exhibited two pulmonary nodules, neither of which was dominant, along with mediastinal and retroperitoneal lymphadenopathy. Immunohistochemical profiling of the small bowel biopsy specimens revealed the tumor was most likely pulmonary in origin.
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Affiliation(s)
- Samir Alkabie
- Northwest Hospital, Randallstown, MD, USA
- Saba University School of Medicine, Devens, MA, USA
| | - Brian Bello
- Northwest Hospital, Randallstown, MD, USA
- Sinai Hospital, Baltimore, MD, USA
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24
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Chow LTC. Femur chondrosarcoma misdiagnosed as acute knee arthritis and osteomyelitis--further developing a hitherto unreported complication of tumor embolic ischemic ileal perforation after arthroscopic lavage. Pathol Res Pract 2014; 210:1095-9. [PMID: 25242025 DOI: 10.1016/j.prp.2014.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/03/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Abstract
The differentiation between osteomyelitis and bone tumor may be difficult due to their overlapping clinical and radiological features. A 25-year-old lady presented with left knee pain and joint effusion associated with redness and hotness. A sub-optimally taken plain radiograph showed mixed osteolytic and osteoblastic lesion in the left lower femur with surrounding soft tissue swelling. Since the clinical diagnosis was acute osteomyelitis and arthritis, arthroscopic lavage was performed as a diagnostic and therapeutic procedure. The removed loose bodies and fibrinous tissue showed pathological features suspicious of chondrosarcoma. Subsequent MRI revealed an infiltrative tumor eroding through the cortex and joint cartilage. En bloc excision of the left lower femur, upper tibia including the knee joint and patella was performed, and the final diagnosis was grade 2 chondrosarcoma. The patient developed bilateral pulmonary metastasis 33 months after operation. Five months later, she suffered from a hitherto undescribed complication of ischemic perforation of the terminal ileum secondary to tumor embolic arterial obstruction with no macroscopic intestinal or peritoneal tumor deposit. The patient developed multiple brain metastases and died 43 months after initial presentation. Our case illustrates that malignant bone tumor as a differential diagnosis of acute osteomyelitis and arthritis merits recognition and exclusion before arthroscopic lavage, which may enhance tumor dissemination and in our patient results in embolic ischemic ileal perforation.
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25
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Koh SA, Lee KH. [Adenocarcinoma of lung cancer with solitary metastasis to the stomach]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 64:154-7. [PMID: 25252864 DOI: 10.4166/kjg.2014.64.3.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Although hematogenous metastasis of cancer to the gastrointestinal track is rare, it sometime has been reported in patients with malignant melanoma and breast cancer. However, it is extremely rare for lung cancer to metastasize to the stomach, not to mention solitary gastric metastasis. Herein, the authors report a case of a 69-year-old man who was initially diagnosed with lung cancer with synchronous primary gastric cancer which proved to be lung cancer with solitary gastric metastasis after the operation.
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Affiliation(s)
- Sung Ae Koh
- Division of Hemato-Oncology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyung Hee Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
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26
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Di JZ, Peng JY, Wang ZG. Prevalence, clinicopathological characteristics, treatment, and prognosis of intestinal metastasis of primary lung cancer: a comprehensive review. Surg Oncol 2014; 23:72-80. [PMID: 24656432 DOI: 10.1016/j.suronc.2014.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 02/11/2014] [Accepted: 02/27/2014] [Indexed: 12/17/2022]
Abstract
AIM Lung cancer is mostly diagnosed at the advanced stage of disease. This review focused on prevalence, clinicopathological characteristics, treatment, and prognosis of intestine metastasis of primary lung cancer. METHODS Published literature was searched using PubMed/Medline databases to extract studies on primary lung cancer metastasized to the intestine and then analyzed statistically. RESULTS A total of 57 case reports and 3 retrospective studies were obtained from PubMed database. The prevalence of small bowel metastasis of primary lung cancer ranged between 2.6 and 10.7%. Histologically, poor tumor differentiation and advanced T and N stages of primary lung cancer associated with intestinal metastasis. Clinically, primary lung cancer metastasized to the intestine led to three frequent clinical presentations, i.e., intestine perforation, obstruction, and bleeding. The time interval between diagnosis of primary tumor and manifestation of intestinal metastasis ranged between 2 week and 4 years, while the time was within one year for 36 reported cases. 70% (45 of 63 cases) of patients did have an extra-intestinal metastasis at diagnosis of intestine metastasis. The median survival rate of 79 patients with follow-up data was 2.3 month and the old age, extra-intestinal metastasis, and intestine perforation were associated with poor prognosis. CONCLUSION This study suggests that the primary lung cancer metastasized to the small bowel is not so rare as it is thought. Clinical management and treatment decision will be warranted and considered accordingly.
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Affiliation(s)
- Jian-Zhong Di
- Department of Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, Shanghai 200233, China
| | - Jia-Yuan Peng
- Department of Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, Shanghai 200233, China.
| | - Zhi-Gang Wang
- Department of Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, Shanghai 200233, China
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27
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Salemis NS, Nikou E, Liatsos C, Gakis C, Karagkiouzis G, Gourgiotis S. Small bowel perforation secondary to metastatic non-small cell lung cancer. A rare entity with a dismal prognosis. J Gastrointest Cancer 2013; 43:391-5. [PMID: 22033892 DOI: 10.1007/s12029-011-9329-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The incidence of gastrointestinal metastases from lung cancer is higher than previously thought as they have been reported in 2-14% of the cases in autopsy studies. However, clinically significant metastases are rare. Small bowel perforation secondary to metastatic non-small cell lung cancer is a very rare clinical entity. The aim of this study is to describe a case of ileal perforation in a patient with intestinal metastases of a non-small cell lung cancer, along with a review of the literature. METHODS A 57-year-old male with a history of non-small cell lung cancer was referred to our emergency department with signs and symptoms of acute surgical abdomen. A computed tomography scan demonstrated dilated small bowel loops, liver deposits, and signs of perforation of an intra-abdominal hollow viscus. RESULTS Emergency exploratory laparotomy revealed diffuse purulent peritonitis and a perforated ileal tumor. A segmental small bowel resection and primary anastomosis were performed. Histological and immunohistochemical findings were consistent with a metastatic non-small cell lung carcinoma. Additional evaluation revealed widespread metastatic disease. Unfortunately, despite adjuvant treatment, the patient died of progressive disease 2 months after surgery. CONCLUSIONS Small bowel perforation due to metastatic non-small cell lung cancer is a very rare clinical entity. The possibility of small bowel metastases should be kept in mind in patients with lung cancer presenting with an acute abdomen. Intestinal perforation occurs in advanced stages and is usually a sign of widespread disease. Aggressive surgery can provide effective palliation and may improve short-term survival. The prognosis is however dismal.
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Affiliation(s)
- Nikolaos S Salemis
- Second Department of Surgery, Army General Hospital, 19 Taxiarhon Str, 19014, Kapandriti, Athens, Greece.
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28
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Small Bowel Intussusception due to Metastasized Sarcomatoid Carcinoma of the Lung: A Rare Cause of Intestinal Obstruction in Adults. Case Rep Surg 2012; 2012:962683. [PMID: 23346451 PMCID: PMC3546449 DOI: 10.1155/2012/962683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 12/11/2012] [Indexed: 02/07/2023] Open
Abstract
Although small bowel intussusception is one of the most common abdominal emergencies in childhood, it is rare in adults and usually occurs as a result of an underlying pathology. Sarcomatoid carcinoma, a very rare subtype of lung cancer, rarely metastasizes to small bowel and causes complications. In this paper, we aim to describe a patient with small bowel intussusception caused by an isolated small bowel metastasis of the sarcomatoid carcinoma of the lung by reviewing the literature.
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29
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Chung WP, Song HL, Ho CL, Chiu NT, Su WC. Gastric perforation secondary to regression of lung adenocarcinoma after gefitinib treatment. J Clin Oncol 2012; 31:e6-8. [PMID: 23169516 DOI: 10.1200/jco.2012.43.5578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Wei-Pang Chung
- National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
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30
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Zhang Z, Chen H, Li X. Small bowel perforation secondary to metastatic lung cancer with emphasis on the administration of erlotinib: a case report. JOURNAL OF MEDICAL COLLEGES OF PLA 2012. [DOI: 10.1016/s1000-1948(12)60025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sakai H, Egi H, Hinoi T, Tokunaga M, Kawaguchi Y, Shinomura M, Adachi T, Arihiro K, Ohdan H. Primary lung cancer presenting with metastasis to the colon: a case report. World J Surg Oncol 2012; 10:127. [PMID: 22741562 PMCID: PMC3433337 DOI: 10.1186/1477-7819-10-127] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 06/28/2012] [Indexed: 01/06/2023] Open
Abstract
Although about 50% of lung cancers have distant metastasis at the time of initial diagnosis, colonic metastases are extremely rare. This report presents a rare clinical case of colonic metastasis from primary squamous cell carcinoma of the lung. A 60-year-old female with anorexia and fatigue was referred to the department of pulmonary surgery in our hospital. The patient was diagnosed with primary squamous cell carcinoma of the lung, T2b N3 M1b Stage IV, and chemoradiotherapy was initiated. This treatment led to a good partial response in the primary lung lesion without any new metastatic lesions. The patient developed left abdominal pain due to a bulky sigmoid colon tumor 6 months later, and was preoperatively diagnosed with primary colon cancer. She underwent colonic resection, and the pathology specimen demonstrated poorly differentiated squamous cell carcinoma that was suspected to be colonic metastasis from the primary lung cancer. The postoperative course was uneventful, and she was discharged. Chemotherapy for the lung cancer was scheduled in the department of pulmonary surgery. This report presented a rare case of colonic metastasis from lung cancer. When patients with advanced primary lung cancer complain of abdominal symptoms, we should consider gastrointestinal tract metastasis from lung cancer.
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Affiliation(s)
- Hiroshi Sakai
- Department of Gastroenterological Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Sileri P, D Ugo S, Blanco GDV, Lolli E, Franceschilli L, Formica V, Anemona L, De Luca C, Gaspari AL. Solitary metachronous gastric metastasis from pulmonary adenocarcinoma: Report of a case. Int J Surg Case Rep 2012; 3:385-8. [PMID: 22634567 PMCID: PMC3376723 DOI: 10.1016/j.ijscr.2012.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/28/2012] [Accepted: 04/10/2012] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Gastric metastases from lung adenocarcinoma are rare and usually associated with disseminated disease. The great majority is asymptomatic and in few cases discovered during autopsy studies. Reports of single metachronous metastases during the lifetime are anecdotal. We describe a case of solitary gastric metastasis 5 years after lung surgery. PRESENTATION OF CASE A 68-year-old male submitted in 2006 to right lobectomy for lung adenocarcinoma was referred at Emergency Room department in 01/2011 because of chronic epigastric pain. Radiologic and endoscopic evaluation showed a bulky lesion inside the stomach, originating from the muscular layer, suspected for GIST. He underwent a subtotal gastrectomy and the pathologic examination revealed an undifferentiated adenocarcinoma, positive for Thyroid Transcriptional Factor-1, Cytokeratin 7, AE 1/3 and CEA, confirming the pulmonary origin. DISCUSSION At the time of diagnosis about 50% of lung cancer are metastatic, with survival rates of 1% at 5-year. Gastric metastasis is very rare; autopsy studies report an incidence of 0.2-0.5%. They develop in the submucosa, usually without any symptom and the diagnosis is incidental during the staging of primary cancer or the follow-up. There are no guidelines about surgical treatment; however few cases of long-term survival following the operation were reported. Pathologic diagnosis is difficult, but the immunohistochemical staining helps to recognize the primary origin. CONCLUSION Solitary metachronous gastric metastasis from pulmonary adenocarcinoma is an exceptional event, but it could happen during the follow-up. It seems that a radical resection, in absence of systemic implants, might provide survival benefits in selected patients.
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Affiliation(s)
- Pierpaolo Sileri
- Department of Surgery, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Stefano D Ugo
- Department of Surgery, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | | | - Elisabetta Lolli
- Department of Gastroenterology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Luana Franceschilli
- Department of Surgery, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Vincenzo Formica
- Department of Oncology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Lucia Anemona
- Department of Pathology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Carmela De Luca
- Department of Surgery, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Achille L. Gaspari
- Department of Surgery, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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Yamagishi H, Sakamoto T, Matsuda T, Nakajima T, Saito Y. Solitary metastatic colon cancer showing a small depressed configuration. Intern Med 2012; 51:2321-4. [PMID: 22975541 DOI: 10.2169/internalmedicine.51.7559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein present a case of IIc-like metastatic lung cancer that was detected early. A 65-year-old man presented with diarrhea and difficulty walking. Colonoscopy demonstrated a depressed lesion in the descending colon. However, the appearance of the lesion by endoscopy with a magnifying objective was not compatible with early colon cancer. Therefore, we performed diagnostic endoscopic mucosal resection to allow for an examination of the whole lesion. A histological examination demonstrated lung cancer metastasis to the colon. Only 1.6% of lung cancers metastasize to the large intestine, and metastatic colorectal cancer is not usually detected at an early stage. In the present case, however, endoscopy and a histological examination revealed alterations in the mucosal configuration of the lesion, which were unusual for early colon cancer.
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Lung Adenocarcinoma Staged as an Unknown Primary Presenting with Symptomatic Colon Metastases: Staging by 18F-FDG PET/CT. Nucl Med Mol Imaging 2011; 45:314-8. [PMID: 24900023 DOI: 10.1007/s13139-011-0096-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022] Open
Abstract
A 66-year-old man, who presented with bright red blood per rectum, was referred for an (18)F-FDG PET/CT after colonoscopy showed two suspicious colon masses, which were biopsied to reveal an adenocarcinoma of unknown origin. PET/CT showed two intensely FDG-avid colon masses as well as an unsuspected FDG-avid lung mass, which was biopsied to reveal a primary lung adenocarcinoma. Immunohistochemistry confirmed the two colon metastases were of pulmonary origin. It is extremely rare for lung carcinoma to present with symptomatic colon metastases, with only 11 cases described in the literature. We report the first case of the utility of (18)F-FDG PET/CT in staging a patient who presented with symptomatic colon metastases of an unknown primary lung malignancy.
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Fujiwara A, Okami J, Tokunaga T, Maeda J, Higashiyama M, Kodama K. Surgical treatment for gastrointestinal metastasis of non-small-cell lung cancer after pulmonary resection. Gen Thorac Cardiovasc Surg 2011; 59:748-52. [PMID: 22083693 DOI: 10.1007/s11748-011-0811-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/04/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Gastrointestinal metastasis is not common in recurrent non-small-cell lung cancer (NSCLC) patients. There is thus limited information on clinical outcome for these patients. This report presents the clinical characteristics and outcomes of patients with gastrointestinal metastasis after pulmonary resection. METHODS The study retrospectively analyzed nine NSCLC patients with gastrointestinal metastases. RESULTS Gastrointestinal metastases were observed in the small intestine (n = 4), colon or rectum (n = 4), and stomach (n = 1). All of the patients were symptomatic. The median survival after gastrointestinal recurrence was 10.8 months. Gastrointestinal surgery was performed in five patients, whereas no cancer treatment was indicated in the remaining four patients. Three patients who underwent surgery for a solitary metastasis survived for more than 2 years after surgery with no other recurrence. CONCLUSION Surgical resection of gastrointestinal metastasis is indicated not only for symptom relief but also for providing a potentially long-term survival if the patients are properly selected.
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Affiliation(s)
- Ayako Fujiwara
- Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka, 537-8511, Japan
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Nishizawa Y, Kobayashi A, Saito N, Nagai K, Sugito M, Ito M, Nishizawa Y. Surgical management of small bowel metastases from primary carcinoma of the lung. Surg Today 2011; 42:233-7. [PMID: 22045233 DOI: 10.1007/s00595-011-0005-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 03/01/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the treatment and outcomes in a series of seven cases of small bowel metastases from lung cancer. METHODS A total of 4114 patients with lung cancer were referred to this institution from 1995 to 2005. Seven (0.17%) developed symptomatic small bowel metastasis and were treated surgically. The clinical, radiological, and pathological records were reviewed. RESULTS Small bowel metastases were diagnosed from 0 to 31 months (mean 11.5 months) after the diagnosis of lung cancer. The clinical symptoms at presentation were acute peritonitis in two patients and abdominal pain in five. Small bowel metastasis was suspected on abdominal X-ray in three cases, computed tomography in two, small bowel radiography in one, and endogastroduodenoscopy in one. All patients underwent surgery and there were no perioperative deaths. Intestinal resection was performed in five cases and a bypass in two. A small bowel metastasis was found in the ileum in four patients. The mean survival period was 7.7 months after surgery. One patient lived for 22 months after bowel resection. Oral intake was possible 1 month after surgery in six cases. CONCLUSION Surgical management should be considered as palliative treatment in patients with a bowel obstruction or peritonitis caused by primary lung cancer.
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Affiliation(s)
- Yuji Nishizawa
- Colorectal and Pelvic Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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Isobe K, Hata Y, Sakaguchi S, Sato K, Sano G, Sugino K, Sakamoto S, Takai Y, Shibuya K, Takagi K, Homma S. Role of fluoro-2-deoxyglucose positron emission tomography for the detection of gastrointestinal tract lesions in patients with lung cancer. Thorac Cancer 2011; 2:190-195. [PMID: 27755851 DOI: 10.1111/j.1759-7714.2011.00060.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to clarify the clinical characteristics of lung cancer patients with abnormal accumulation of fluoro-2-deoxyglucose (FDG) in the gastrointestinal tract imaged by positron emission tomography (PET). METHODS Of 1071 consecutive patients with primary lung cancer who underwent PET from October 2005 through to March 2010, 25 patients (2.3%) showed localized abnormal FDG accumulation in the gastrointestinal tract. We retrospectively compared the location of abnormal accumulation in the gastrointestinal tract, the maximum standardized uptake value in 1 hour, and final clinical diagnosis. RESULTS Of the 25 cases, 12 (48%) were true PET-positive cases (esophageal cancer in one case, gastric cancer in one, colorectal cancer in seven, gastrointestinal stromal tumor in one, and lung cancer metastasis to the stomach and small intestine in one patient each). The 13 cases with false PET-positives were gastric polyp in one, gastritis in four, colon polyp in two, diverticulitis in one, and normal physiological accumulation in five. There was also a significant difference between malignancy and benign intestinal accumulation excluding the stomach (P = 0.002). CONCLUSION PET was useful for screening the gastrointestinal tract (except the stomach) for malignancy in lung cancer patients.
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Affiliation(s)
- Kazutoshi Isobe
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoshinobu Hata
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Shinji Sakaguchi
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Keita Sato
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Go Sano
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Susumu Sakamoto
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yujiro Takai
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Kazutoshi Shibuya
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Keigo Takagi
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JapanDepartment of Chest Surgery, Toho University Omori Medical Center, Tokyo, JapanDepartment of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
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Tanaka T, Minami S, Tsutsumi R, Azuma T, Matsuo S, Abe K, Hayashi T, Eguchi S. A metastatic jejunal tumor from squamous cell carcinoma of the lung found in an intestinal perforation. Case Rep Gastroenterol 2011; 5:636-41. [PMID: 22171215 PMCID: PMC3237110 DOI: 10.1159/000334426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
An 85-year-old male with advanced squamous cell carcinoma of the lung, who was diagnosed about 10 years prior to his current presentation, suddenly complained of abdominal pain and underwent an abdominal computed tomography scan, which revealed free air and massive ascites. He was admitted to our hospital for acute peritonitis and emergency surgery was performed. During the surgical procedure, a perforation of the jejunum was diagnosed and repaired. He was diagnosed to have a metastatic tumor originating from a squamous cell carcinoma of the lung. He improved and was transferred to the former hospital on the 27th postoperative day. Jejunal metastasis from squamous cell carcinoma of the lung is rare, and the prognosis of peritonitis due to a perforated intestinal metastasis from lung cancer is poor. There have been 10 reports of jejunal metastasis of squamous cell carcinoma of the lung reported in Japan between 2000 and 2011. Therefore, when patients with advanced lung cancer present with acute abdomen, it is necessary to keep in mind the possibility of a gastrointestinal metastatic tumor.
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Affiliation(s)
- Takayuki Tanaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigeki Minami
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryuji Tsutsumi
- Department of Surgery, National Health Insurance Hirado Municipal Hospital, Hirado, Japan
| | - Takashi Azuma
- Department of Surgery, Nagasaki Prefecture Shimabara Hospital, Shimabara, Japan
| | - Shigetoshi Matsuo
- Department of Surgery, Nagasaki Prefecture Shimabara Hospital, Shimabara, Japan
| | - Kuniko Abe
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomayoshi Hayashi
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Colonic metastasis from primary lung adenocarcinoma: case report and review of the literature. Med Oncol 2011; 29:644-7. [PMID: 21516483 DOI: 10.1007/s12032-011-9954-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 04/08/2011] [Indexed: 12/13/2022]
Abstract
We report a rare case of a 38-year-old woman with metastatic colonic adenocarcinoma from primary lung adenocarcinoma detected by PET/CT. She underwent colonoscopy and adenocarcinoma was diagnosed in the pathology report, which was the same as that for lymph node biopsy from a left supraclavicular lymph node. We used immunohistochemistry to diagnose primary adenocarcinoma of the lung with colonic metastasis. Owing to mutation in exon 19 of EGFR gene, targeted therapy was given to her with a prescription of oral gefitinib for 1 month as first-line treatment. It was chosen to further treat the patient with chemotherapy and radiotherapy. As the patient was suffering from increasing coughing and sputum, radiotherapy and chemotherapy were subsequently cancelled. Since the general condition of the patient was relatively poor, Tarceva was therefore prescribed. The patient had lived for 5 more months since the diagnosis of metastatic colonic adenocarcinoma.
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40
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Tan KK, Bang SL, Ho CK. Surgery for perforated small bowel malignancy: a single institution's experience over 4 years. Surgeon 2011; 10:6-8. [PMID: 22233550 DOI: 10.1016/j.surge.2010.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/09/2010] [Accepted: 12/10/2010] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Surgery for perforated small bowel malignancy is associated with dismal morbidity and mortality rates. The aim of the paper was to highlight our institution's surgical experience in the management of patients with malignant small bowel perforation. METHODS A retrospective review of all patients who underwent operative intervention for malignant small bowel perforation from 2004 to 2007 was performed. The diagnosis was confirmed upon histological evaluation. RESULTS Emergency surgery was performed in seven patients with perforated small bowel malignancy during the study period. All were above 55 years old, with the majority (6/7) having an ASA score of 3 and above. Pneumoperitoneum on chest radiograph was seen in only one patient while computed tomographic scans demonstrating the pathology were performed in the rest. All patients underwent exploratory laparotomy with resection of the diseased segments within 24 h of admission. Jejunum and the ileum were the sites of perforation in six and one patients, respectively. Three patients had synchronous small bowel tumours. Two patients had stoma created due to extensive peritoneal soilage and haemodynamic instability. Lymphoma was the aetiology in four patients. The other pathologies included leiomyosarcoma (n = 1) and metastatic lung tumours (n = 2). The 30-day peri-operative mortality rate was 42.9% (n = 3). One was discharged to a hospice while another two received chemotherapy upon discharge. These three patients passed away within a year from the surgery. The last patient defaulted follow up. CONCLUSION In our small series, patients who were admitted for perforated small bowel malignancy have a high peri-operative mortality rates. For those who survived the initially operation, the long term outlook is still dismal.
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Affiliation(s)
- Ker-Kan Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Azevedo CRASD, Cezana L, Moraes ESPD, Begnami MDFDS, Paiva Júnior TF, Dettino ALA, Fanelli MF. Synchronous thyroid and colon metastases from epidermoid carcinoma of the lung: case report. SAO PAULO MED J 2010; 128:371-4. [PMID: 21308162 PMCID: PMC10948072 DOI: 10.1590/s1516-31802010000600011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 05/15/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Non-small cell lung cancer (NSCLC) progresses to distant metastases in most cases. The most frequent sites for distant metastases are the bones, central nervous system, adrenal glands and liver. Dissemination to the skin, myocardium, thyroid gland and intestine may occur, but is rare. CASE REPORT We describe a case of squamous cell carcinoma in the lungs, with metastases in the colon and thyroid, in a 66-year-old female patient. The lesion was unresectable and chemotherapy was started. The patient evolved with intestinal subocclusion, and colonoscopy showed the presence of a polyp. Biopsy and immunohistochemical analysis on the polyp showed that it was compatible with squamous cell carcinoma of pulmonary origin. At a follow-up consultation, the patient presented a thyroid nodule. A aspiration biopsy and cellblock immunohistochemistry confirmed the squamous cell carcinoma of pulmonary origin. After third-line chemotherapy, the patient progressed with acute obstructive abdomen due to a retroperitoneal mass. She underwent exploratory laparotomy and died due to surgical complications. Metastases to the thyroid and colon are rarely reported in cases of epidermoid carcinoma of the lungs. Gastrointestinal involvement in pulmonary metastases may affect the stomach, small intestine and colon, and cases of bleeding and perforation have already been reported. Although richly vascularized, the thyroid is an infrequent site for metastases. Such sites reflect poor prognoses for the clinical evolution. We did not find any previous reports in the literature, on lung cancer with metastases concomitantly in the colon and thyroid, in a single patient.
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Weng MW, Wang HC, Chiou JC, Lin SL, Lai RS. Colonic metastasis from a primary adenocarcinoma of the lung presenting with acute abdominal pain: a case report. Kaohsiung J Med Sci 2010; 26:40-4. [PMID: 20040472 DOI: 10.1016/s1607-551x(10)70007-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Colonic metastasis from lung cancer is rare and generally asymptomatic. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain due to intestinal obstruction caused by the metastatic colon tumor. The patient underwent emergency colonoscopy and the pathologic report was adenocarcinoma, which was the same as that for a bronchoscopic biopsy from a large lung mass. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7, and negative for cytokeratin 20 and caudal-related homeobox transcription factor 2 on both lung biopsy and colon surgical specimens. Accordingly, we used immunohistochemistry for thyroid transcription factor-1, cytokeratin 7, cytokeratin 20 and caudal-related homeobox transcription factor-2 to diagnose primary adenocarcinoma of the lung with colonic metastasis.
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Affiliation(s)
- Ming-Wei Weng
- Department of Internal Medicine, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan
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43
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Garrigós L, Iglesias M, Lloreta J, Jimeno J, Arriola E. Perforación intestinal secundaria a metástasis de neoplasia primaria de pulmón. Cir Esp 2010; 87:257-9. [DOI: 10.1016/j.ciresp.2009.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
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A patient with four-year survival after nonsmall cell lung carcinoma with a solitary metachronous small bowel metastasis. JOURNAL OF ONCOLOGY 2010; 2010:616130. [PMID: 20224647 PMCID: PMC2833307 DOI: 10.1155/2010/616130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 01/05/2010] [Accepted: 01/06/2010] [Indexed: 02/08/2023]
Abstract
Solitary small bowel metastasis secondary to lung cancer is very uncommon. In this report, we present a patient with NSCLC and a metachronous solitary metastasis of the jejunum. She is alive without evidence of disease and doing well four years after palliative surgery, radiotherapy, and chemotherapy. To the best of our knowledge, this is the first case report describing a prolonged survival in a patient with a symptomatic solitary small bowel metastasis treated with palliative surgery, chemo- and radiotherapy instead of complete surgical resection.
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Gocho K, Isobe K, Kaburaki K, Honda Y, Mitsuda A, Akasaka Y, Shimada N, Takagi K, Homma S. Malignant pleural mesothelioma presenting as an acute surgical abdomen due to metastatic jejunal perforation. Intern Med 2010; 49:597-601. [PMID: 20228599 DOI: 10.2169/internalmedicine.49.2859] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 52-year-old man was admitted to our hospital in June 2008 presenting abnormal tumor lesions along the left pleura on chest X-ray. The needle-biopsied specimen of the left pleura proved the biphasic type of malignant mesothelioma. However, he complained of acute abdominal pain 7 days after the diagnosis. Chest X-ray revealed free air below the right diaphragm. Emergency surgery revealed a 4-cm perforating jejunal tumor with peritonitis. Histopathology of the resected jejunum demonstrated a metastatic tumor of malignant pleural mesothelioma. This is the first reported case of malignant pleural mesothelioma presenting as an acute surgical abdomen due to jejunal metastasis with perforation.
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Affiliation(s)
- Kyoko Gocho
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo
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Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study. Gastrointest Endosc 2010; 71:131-8. [PMID: 19883907 DOI: 10.1016/j.gie.2009.07.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 07/02/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Duodenal perforations during diagnostic upper endoscopy are rare; however, when therapeutic techniques are performed, the reported incidence is as great as 2.8%. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. OBJECTIVE To compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure. DESIGN Randomized, controlled animal study. SETTING Animal facility laboratory. ANIMALS Domestic pigs (24 females). INTERVENTIONS Large (10-mm) duodenal perforations were created by using an endoscopic needle-knife. The animals were randomly assigned to either open surgical repair (n=12) or endoscopic closure by using the OTSC system (n=12). Pressurized leak tests were performed during necropsy. MAIN OUTCOME MEASUREMENTS One major bleed occurred because of a liver injury during creation of the duodenotomy. Mean time for endoscopic closure was 5 minutes (range, 3-8 min; SD +/- 2). No complications occurred during any of the closure procedures. At necropsy, all OTSC and surgical closures demonstrated complete sealing of duodenotomy sites. Pressurized leak tests demonstrated a mean burst pressure of 166 mm Hg (range, 80-260; SD +/- 65) for OTSC closures and 143 mm Hg (range, 30-300, SD +/- 83) for surgical sutures. Ex vivo intact duodenal specimens exhibited a mean burst pressure of 247 mm Hg (range, 200-300; SD +/- 35), which was significantly higher compared with in vivo OTSC and surgical closures (P < .01). There were no significant differences between burst pressures of OTSC and surgical closures (P = .461). LIMITATIONS Nonsurvival setting. CONCLUSIONS Endoscopic closure of duodenal perforations by using the OTSC system is comparable with surgical closure in a nonsurvival porcine model. This technique is easy to perform and seems suitable for repairing duodenal perforations.
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Acute abdomen: a rare presentation of lung cancer metastasis. Case Rep Med 2009; 2009:903897. [PMID: 19841757 PMCID: PMC2762241 DOI: 10.1155/2009/903897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/25/2009] [Indexed: 11/24/2022] Open
Abstract
Surgical emergencies caused by bowel metastases from carcinoma of the lung are very rare. We describe two cases of symptomatic gastrointestinal metastatic small cell carcinoma: the first one concerns a 69-year-old man with an acute abdomen and the second is a 72-year-old man complaining of a gastric ulcer symptoms. We also discuss the current management and the prognosis of these patients.
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Facy O, Radais F, Billard L, Chalumeau C, Fernoux P, Bizollon MH, Ortega-Deballon P. Clinical images. Gastric perforation caused by metastatic lung carcinoma. Am J Surg 2008; 197:e5-6. [PMID: 18722581 DOI: 10.1016/j.amjsurg.2007.12.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 12/14/2007] [Accepted: 12/14/2007] [Indexed: 11/26/2022]
Abstract
A case of gastric perforation caused by metastases of small-cell lung carcinoma in an 85-year-old man is reported. This complication revealed the neoplasm. Biopsy should always be done in patients with gastric perforations, even if there is no palpable tumor. Minimal surgery is warranted because this event occurs often in patients with advanced disease and poor prognosis.
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Affiliation(s)
- Olivier Facy
- Department of Digestive, Thoracic, and Oncologic Surgery, University Hospital of Dijon, Dijon, France.
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