Analysis of gastrointestinal metastasis of primary lung cancer: Clinical characteristics and prognosis

Combined gastroscopic and laparoscopic resection of gastric metastatic adenosquamous carcinoma from lung: A case report

BACKGROUND

Primary lung cancer is the leading cause of cancer-related death worldwide. Common metastatic sites include the brain, liver, bones, and adrenal glands. However, gastric metastases from lung cancer are rare. This case may be the first report of a combined gastroscopic and laparoscopic resection for gastric metastatic adenosquamous carcinoma (ASC).

CASE SUMMARY

We report a case of gastric metastasis from lung cancer. The patient was a 61-year-old Han Chinese female who first attended our hospital complaining of a persistent cough, leading to the diagnosis of advanced-stage lung adenocarcinoma. After more than four years of chemotherapy, the patient began to experience epigastric pain. Endoscopy was performed, and pathological examination of biopsy specimens confirmed that the gastric lesion was a metastasis from lung cancer. The lesion was successfully resected by combined gastroscopy and laparoscopy. Histopathological examination of the resected gastric specimen revealed ASC.

CONCLUSION

Gastric metastases from lung cancer are rare. Endoscopy, histological and immunohistochemical staining are useful for diagnosing metastatic lesions. Surgical management may provide extended survival in appropriately selected patients.

Primary Lung Squamous Cell Carcinoma With Intestinal Metastasis: A Case Report and Literature Review

Lung squamous cell carcinoma (LUSC) is characterized by a high rate of metastasis and recurrence, leading to a poor prognosis for affected patients. Intestinal metastasis of LUSC is a rare clinical occurrence. Treatment options for LUSC patients with intestinal metastasis are limited, and no standard therapy guidelines exist for managing these cases. In this review, we discuss the clinical features, diagnosis, and treatment of LUSC patients with intestinal metastasis and present a rare case of LUSC with intestinal metastasis. We describe a patient who presented with a severe cough and chest pain and diagnosed with LUSC and bone tumor. Initially, the primary LUSC and bone tumor were controlled with standard treatments. However, the primary LUSC reoccurred shortly after treatment, this time with intestinal metastasis, for which effective treatments are lacking. Our observation from the case suggests that LUSC metastasizing to intestinal tract is associated with a poorer prognosis.

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

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

An unusual presentation of a primary lung adenocarcinoma: A case report

INTRODUCTION AND IMPORTANCE

Lung cancer is one of the most common malignancies worldwide and common sites of metastasis are to brain, liver, adrenal glands, and bones [1]. Metastasis to the gastrointestinal (GI) tract is extremely rare (<1%) and the most common site is the small intestine [5].

CASE PRESENTATION

A 60-year-old female referred for intermittent colicky abdominal pain and diarrhoea, with cross-sectional imaging showing a distal small bowel mass with lymphadenopathy. Malignancy workup revealed an additional mediastinal mass and raised tumour marker carcinoembryonic antigen (CEA). Bronchoscopy confirmed primary lung adenocarcinoma of the mediastinal mass. Given the raised CEA, evolving obstructive symptoms, and concerns for synchronous lung and gastrointestinal primaries, the patient proceeded to have a small bowel resection leading to the diagnosis of a GI lung metastasis.

CLINICAL DISCUSSION

If Symptomatic, suggested treatment of lung metastasis to the GI tract is surgical resection. Current evidence suggests that in isolated GI metastases, resection may have a therapeutic benefit and an association with overall survival rate.

CONCLUSION

In patients with symptomatic or isolated GI lung metastasis, surgical resection should be considered for treatment and management of metastatic disease. The role of tumour marker CEA in primary lung adenocarcinoma is unclear.

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

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

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

BACKGROUND

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

CASE SUMMARY

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

CONCLUSION

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

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

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

Endoscopic manifestations and treatment outcomes of asymptomatic gastric metastases from primary lung adenocarcinoma: Report of two cases

Metastatic spread of lung adenocarcinoma to the stomach is rare and most gastric metastases are discovered at the advanced stage due to certain symptoms. The present study reported two cases of asymptomatic gastric metastases from lung adenocarcinoma presenting as diminutive nodules or erosion endoscopically. The manifestations were also visualized under magnifying endoscopy with blue laser imaging (BLI-ME), the two cases share certain common characteristics under BLI-ME, such as an obviously widened intervening part and extended subepithelial capillary network, which indicated that lesions developed beneath the superficial epithelium. Target biopsy and further immunohistochemical staining confirmed that the gastric lesions were metastatic from primary lung cancer. None of the two patients were candidates for surgery due to multiple distant metastases, but the gastric metastases regressed to scars after systemic anticancer therapy. These two cases were presented in order to improve the current understanding of the endoscopic manifestations of early gastric metastases from lung cancer, and the outcomes may demonstrate that systemic treatment is effective for eliminating early gastric metastatic lesions.

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

INTRODUCTION

Gastrointestinal (GI) metastases in lung cancer rarely occur.

CASE REPORT

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

CONCLUSION

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

Metastatic small cell lung cancer presenting as acute appendicitis: a case report

We present a case of extensive stage small cell lung cancer presenting as perforated appendicitis secondary to an appendiceal metastasis. This is a rare presentation with only six reported cases in the literature. Surgeons must be aware of unusual causes for perforated appendicitis as in our case the prognosis can be dire. A 60-year-old man presented with an acute abdomen and septic shock. Urgent laparotomy and a subtotal colectomy were performed. Further imaging suggested the malignancy was secondary to a primary lung cancer. Histopathology demonstrated a ruptured small cell neuroendocrine carcinoma in the appendix with thyroid transcription factor 1 positive immunohistochemistry. Unfortunately, the patient deteriorated due to respiratory compromise and was palliated day six postoperatively. Surgeons should consider a broad differential diagnosis for the cause of acute perforated appendicitis as this can rarely be due to a secondary metastatic deposit from a widespread malignant process.

Squamous cell lung carcinoma with gastrointestinal metastasis: a case report and review of literature

Squamous cell lung carcinoma (LUSC) originates from squamous cells and has a high rate of metastasis and recurrence. The lack of effective genetic targets and specific therapies has resulted in a poor prognosis for patients with LUSC. Gastrointestinal metastasis of LUSC is a rare occurrence in clinical practice. Patients with gastrointestinal metastasis usually have worse overall survival and the process of diagnosis is more complicated than those with metastasis elsewhere. What's more, there are no helpful guidelines for treating patients with a clinically confirmed diagnosis of gastrointestinal metastasis, which means the treatment method is limited. Here, we review the clinical features, diagnosis, and treatment of LUSC patients with gastrointestinal metastasis and report a rare case of LUSC accompanied by gastrointestinal metastasis. The patient was admitted to the hospital with coughing and hemoptysis. A tumor was found in his lung, and lesions were initially controlled with standard treatment. The patient's tumor re-occurred again shortly for which treatment was lacking. Without effective treatment methods, the disease was difficult to control. Our learnings from the case demonstrate that LUSC metastasizes to secondary lymphoid organs of the gastrointestinal tract, usually with a poor prognosis.

Intraluminal Small Bowel Metastasis From Primary Lung Cancer

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

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

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

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

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Cytokine Release Syndrome and Immune-Related Pneumonitis Associated With Tumor Progression in a Pulmonary Pleomorphic Carcinoma Treated With Nivolumab Plus Ipilimumab Treatment: A Case Report

Effective control of severe immune-related adverse events, including cytokine release syndrome (CRS), is essential for the success of immunotherapy. We present a case of a granulocyte colony-stimulating factor–producing pleomorphic lung carcinoma treated with nivolumab plus ipilimumab which developed CRS and severe immune-related pneumonitis. The effect of immunotherapy was heterogeneous; gastric metastasis was eliminated, but the pulmonary lesion had primary resistance. Steroid and tocilizumab were successful in controlling CRS, but additional infliximab was necessary to control pneumonitis. To control immune-related adverse events, it is important to choose immunosuppressive agents to the specific target organ and inflammatory cells.

Duodenal Metastasis of Pulmonary Pleomorphic Carcinoma: A Case Report

Pulmonary pleomorphic carcinoma (PPC) is a rare subtype of lung sarcomatoid carcinoma that has a poor prognosis, and no standard therapy has been established. Here, we report the case of a 74-year-old man with PCC who showed rare duodenal metastasis. He was referred to our hospital with a mass shadow in the right lung. The patient was diagnosed with PPC clinical stage II B on the basis of immunohistochemical staining from bronchoscopy, and the tumor proportion score of programmed death-ligand 1 was 80%. He did not want any treatment. A year and a half later, progressive anemia was detected. The primary tumor was stable; however, abdominal computed tomography and esophagogastroduodenoscopy revealed a duodenal tumor with stenosis. He was diagnosed with duodenal metastasis from PPC, and he underwent gastrojejunal bypass surgery to prevent bowel obstruction. After surgery, he received pembrolizumab for chemotherapy. However, owing to the progression of peritoneum dissemination, he died 2 months later due to the onset of melena.

Clinicopathological characteristics of colorectal metastases from lung cancer: systematic review of the case reports in the Japanese literature

Since colorectal metastases from primary lung cancer are rare, the location of metastatic lesion and prognostic factors have not been well evaluated. Therefore, we carried out a systematic review and meta-analysis to assess the clinicopathological characteristics and prognostic factors of Japanese patients with colorectal metastasis from lung cancer. We searched the Ichushi-Web database from January 1964 to December 2020. We found 59 colorectal metastases in 52 cases for this meta-analysis. Small cell carcinoma was shown to have significantly more metastases to the appendix than non-small cell carcinoma. However, there was no significant correlation between location and histology when classified into right and left colons (P = 0.247). The median overall survival after diagnosis was 6 months. Univariate analysis showed that adenocarcinoma (Hazard Ratio (HR) 0.383, P = 0.024), simultaneous metastasis (HR 0.325, P = 0.046), and chemotherapy group (HR 0.482, P = 0.044) were good prognostic factors. Multivariate analysis confirmed that chemotherapy (HR 0.38, P = 0.02) was an independent good prognostic factor for overall survival. In conclusion, although there was no statistical difference, right colon metastases were more frequent than left colon metastases. Chemotherapy may be effective for colorectal metastases from lung cancer.

Dietary flavone from the Tetrastigma hemsleyanum vine triggers human lung adenocarcinoma apoptosis via autophagy

Among all types of cancers, lung cancer ranks first in morbidity and mortality, and non-small cell lung cancer (NSCLC) accounts for 80-85% of all lung cancer cases. Chemotherapy has shown promising results, but the accompanying side-effects cannot be neglected. Herein, we introduce novel flavones (TVF), which were characterized as 3-caffeoylquinic acid, 5-caffeoylquinic acid, quercetin-3-O-rutinoside, and kaempferol-3-O-rutinoside by UPLC-MS/MS, derived from the vine of Tetrastigma hemsleyanum (TV), a traditional Chinese herb and food. TVF exhibited outstanding anti-cancer abilities at the in vitro and in vivo level, and markedly triggered apoptosis via the Bax/Bcl-2/caspase-9/caspase-3 pathway. The intrinsic mechanism study illustrated that TVF might induce apoptosis by activating autophagy by inhibiting the Akt-mTOR pathway, and the main component of TVF, quercetin-3-O-rutinoside, enabled THR308 site binding to block the phosphorylation of Akt, which was further evidenced by molecular docking computation. Our study reveals the excellent anti-cancer ability and inner mechanism of TVF, suggesting TVF as a potential candidate for clinical drug exploitation or dietary supplementation in cancer medication and prevention, providing a promising strategy for cancer chemotherapy.

Lung cancer presenting as an acute appendicitis

Appendiceal metastasis is a rare complication of primary lung cancer and an extremely rare cause of appendicitis. We present the case of a 62-year-old male who presented with right lower quadrant abdominal pain which revealed not only appendiceal inflammation, but also a lung mass and mediastinal lymph nodes. He then proceeded to appendicectomy and two days post-operatively an endobronchial ultrasound-guided biopsy. His mediastinal lymph node biopsy revealed a lung adenocarcinoma and his subsequent appendiceal immunohistochemistry revealed the same staining pattern for thyroid transcription factor 1 (TTF-1) and cytokeratin 7 (CK-7). We conducted a literature review which revealed 12 previous case reports of lung metastasis to the appendix causing appendicitis including three patients in whom appendicitis was the presenting complaint leading to lung cancer diagnosis. This case highlights the diversity of presentations for patients suffering from metastatic lung cancer.

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

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

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

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

Acute perforating appendicitis caused by metastatic squamous cell carcinoma from the lung: A case report

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Extremely rare case of appendiceal metastasis of squamous cell carcinoma of the lung.

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Metastatic appendiceal tumor tend to perforate.

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Surgery is recommended.

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CT and PET-CT are useful for diagnosis.

Introduction

Lung cancer is one of the most common cancers. On the other hand, lung cancer metastasis to the appendix is extremely rare, and in many cases it has been diagnosed with the onset of acute perforating appendicitis.

Presentation of case

An 85-year-old man with fever and abdominal pain visited our hospital. He had a history of squamous cell carcinoma of the left upper and lower lobes, metastasis to the ipsilateral lung and femur. CT showed that a finding of acute perforating appendicitis, emergency cecal resection was performed. Examination of the resected specimen showed that the appendix was thickened overall, with a white nodular structure at the root and a perforation in the middle. The final diagnosis was acute perforating appendicitis caused by metastatic squamous cell carcinoma from the lung. The patient had no particular problems during the postoperative course.

Discussion

A PubMed search was performed, this appears to be the first reported case of appendiceal metastasis of squamous cell carcinoma of the lung. Since squamous cell carcinoma of the lung has a stronger tendency for local extension than other histological types, perforating appendicitis due to distant metastasis to the abdominal organs and metastasis to the appendix was reported as a very valuable case.

Conclusion

Because the progression of concomitant or secondary appendicitis is rapid, we recommend frequent imaging modalities, prophylactic appendectomy be considered for patients who also have lung cancer and imaging findings show suspected metastasis to the appendix.

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

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

[Hemoglobin drop after thrombolytic therapy in a 57-year-old stroke patient with "erosive gastritis"]

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.

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

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

Key points

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

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

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

BACKGROUND

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

CASE

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

CONCLUSION

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

Clinical Characteristics and Prognosis of Gastrointestinal Metastases in Solid Tumor Patients: A Retrospective Study and Review of Literatures

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.

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

Background

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

Case presentation

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

Conclusions

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

Solitary colonic metastasis from primary lung adenocarcinoma first presenting as intestinal obstruction: A case report

RATIONALE

The brain, liver, adrenal glands, and bone are the most common sites of metastatic disease in patients with lung cancer. Symptomatic gastrointestinal metastases are rare. In the present report, we describe a rare case of a patient with intestinal obstruction due to solitary colonic metastasis from primary lung adenocarcinoma, wherein the intestinal obstruction was the first symptom of lung cancer.

PATIENT CONCERNS

A 74-year-old man was admitted to the emergency room with abdominal pain and vomiting, and abdominal computed tomography (CT) indicated obstruction of the ascending colon due to a huge mass.

DIAGNOSIS

The ascending colon cancer was found to be a metastatic adenocarcinoma based on the results of the pathology report. Chest CT and positron emission tomography-CT were performed to identify the cancer origin site. Moreover, immunohistochemical staining of the tissue specimen for thyroid transcription factor 1, cytokeratin 7 (CK7), and CK20 and CT-guided gun biopsy of the lung mass confirmed the presence of an adenocarcinoma that originated from the lung.

INTERVENTION

Right hemicolectomy was performed as the primary treatment.

OUTCOMES

The patient recovered without any problems due to the surgery itself. However, malignant pleural effusion deteriorated, and no additional palliative chemotherapy was performed.

LESSONS

Patients with malignant bowel obstruction along with lung infiltration should be suspected of not only colon cancer with lung metastasis, but also lung cancer with colon metastasis.

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

RATIONALE

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

PATIENT CONCERNS

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

DIAGNOSIS

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

INTERVENTIONS

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

OUTCOMES

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

LESSONS

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

Mutational analysis on gastric, duodenal, bone, and mediastinal lymph node metastases and blood from a case of primary lung adenocarcinoma

Rapid metastasis contributes significantly to the high mortality rates in lung adenocarcinoma. The present study reports a rare case of primary lung adenocarcinoma with concomitant gastric, duodenal, bone, and mediastinal lymph node metastases. A large gene panel based on the next-generation sequencing was used to detect gene mutations in different metastatic sites and blood. The results showed that the gene mutation spectrums among different metastatic foci were roughly similar. The mutation abundance was highest in mediastinal lymph nodes. Unique mutation sites were detected only in mediastinal lymph nodes, bone, and gastric metastatic foci. Despite partial heterogeneity, there are currently no applicable targeted drugs to adopt. In addition, tumor mutation burden (TMB) showed that blood, gastric, bone, and mediastinal lymph node metastases were all TMB-High, while the duodenal metastasis was TMB-Low. This study is the first to report a rare case of newly diagnosed lung adenocarcinoma with concomitant gastrointestinal metastases and to perform mutation analyses on all metastatic foci. Large sample sizes with similar cases are required to gain deeper insights.

Acute appendicitis caused by metastatic adenocarcinoma from the lung: a case report

Background

Appendiceal metastasis from lung cancer is rare. However, it often causes acute appendicitis that requires emergency surgery. We herein report a thought-provoking case of appendiceal metastasis from lung cancer.

Case presentation

A 71-year-old man was diagnosed with advanced lung cancer with multiple metastases and underwent chemotherapy. One month later, he developed acute appendicitis, and laparoscopic appendectomy was promptly performed. A swollen appendix and pus collection were observed during surgery. Histological analysis revealed an invasive adenocarcinoma in the appendix that infiltrated the mucosal, submucosal, and muscular layers. Positive immunostaining of thyroid transcription factor 1 indicated appendiceal metastasis of pulmonary adenocarcinoma, not a primary appendiceal malignancy. The postoperative course was uneventful, and the patient’s pulmonary internist resumed continuous chemotherapy after surgery.

Conclusions

Although appendiceal metastasis from pulmonary adenocarcinoma is rare, it often results in acute appendicitis. Optimal therapy including emergency surgery should be performed without hesitation so that chemotherapy can be resumed as soon as possible.

Multiple gastrointestinal metastases of squamous-cell lung cancer: A case report

RATIONALE

Gastrointestinal multiple metastases of lung cancer are extremely rare. The majority of gastrointestinal metastasis cases are diagnosed at a late stage and the prognosis is extremely poor. This report describes the clinical characteristics and outcomes of a patient with gastrointestinal multiple metastases from squamous-cell lung cancer, with special emphasis on the diagnosis and treatment of metastatic lung cancer.

PATIENT CONCERNS

A 61-year-old man who presented with progressive abdominal distention was admitted to our hospital. Radiological examinations showed changes of post-primary pulmonary tuberculosis and mechanical obstruction of the small bowl. Histopathological findings of gastroscopic examination and biopsy specimens showed a diagnosis of squamous-cell carcinoma in the body of the stomach.

DIAGNOSES

Postoperative histopathology confirmed a gastrointestinal multiple squamous-cell carcinoma in stomach and small bowl. Finally, squamous-cell lung cancer was confirmed by lung biopsy.

INTERVENTIONS

During his hospitalization urgent surgery was performed because of acute abdomen. The patient underwent a laparotomy with curative gastrectomy for gastric cancer and small bowel partial resection. The patient was recommended with combination chemotherapy of carboplatin and paclitaxel for 3 cycles.

OUTCOMES

Six months later after operation, the patient succumbed to respiratory failure.

LESSONS

We searched the related literature of gastrointestinal metastases from lung cancer and the clinical presentation, site of metastasis, diagnosis, treatment, and survival time in these cases were reviewed. The present study may increase the awareness of early diagnosis and appropriate treatment of metastatic lung cancer of gastrointestinal tract.