Gastrointestinal metastasis of primary lung cancer: An analysis of 366 cases

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.

Therapeutic drug monitoring of osimertinib in non-small cell lung cancer and short bowel syndrome: A case report

Short bowel syndrome (SBS) following extensive intestinal resection is often characterized by impaired absorption of orally administered drugs, including tyrosine kinase inhibitors (TKI). We report the case of a patient with EGFR-mutated non-small cell lung carcinoma treated with 80 mg/day of the TKI osimertinib who achieved partial response of the tumour, but was subsequently subjected to a double-barrelled jejunostomy due to ileus. Due to the development of SBS after the bypass surgery, plasma concentrations of osimertinib were monitored using mass spectrometry. The therapeutic drug monitoring confirmed a malabsorption of osimertinib in the patient (108 ng/mL, which is below the 5th percentile of the expected plasma concentration) and was useful to guide adjustments of TKI dosing in order to achieve adequate blood levels (161 ng/mL after increase of the dose to 120 mg/day) in order to maintain tumour control.

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

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

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

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

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

BACKGROUND

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

CASE SUMMARY

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

CONCLUSION

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

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

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

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

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

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.

Gastric Metastasis From Lung Adenocarcinoma: An Uncommon Presentation

Gastric metastasis is an infrequent occurrence, especially when derived from lung adenocarcinomas. They can grossly resemble advanced gastric cancer and require comprehensive evaluations of the patients and their symptoms. Here, we present the case of a 71-year-old patient admitted to our hospital due to intense, cramping abdominal pain. He had been previously diagnosed with a right lower lobe adenocarcinoma of the lung, which was treated in the previous year with chemotherapy and radiotherapy with good clinical response. The abdominal CT scan and the esophagogastroduodenoscopy showed a gastric infiltrating lesion resembling advanced gastric cancer. However, the biopsy showed malignant epithelial neoplasia with features of adenocarcinoma of pulmonary origin. Even though they are an uncommon finding, gastrointestinal metastases may be life-threatening and should be diagnosed as soon as possible, as the advent of molecular studies and new therapies may result in better survival rates.

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.

Capsule Endoscopy-Based Diagnosis of Lung Squamous Cell Carcinoma Associated with Abdominal Pain and Metastasis to Small Intestine: A Case Report

Gastrointestinal metastases of lung cancer are relatively uncommon, yet occur at a higher frequency than would be expected among patients that exhibit a longer survival interval. Metastases that arise in the small intestines are often associated with no or few symptoms such that their early diagnosis can be challenging. In this report, we describe an extremely rare case of a lung squamous cell carcinoma that had metastasized to the small intestine and was associated with symptoms of abdominal pain. The patient underwent capsule endoscopy which detected an irregular mass in the distal ileum that was hemorrhagic, after which laparoscopic ileal resection and anastomosis in parallel with partial bladder resection were performed. Subsequent pathological biopsy confirmed that the intestinal mass was consistent with metastatic squamous cell carcinoma. With surgery and subsequent maintenance therapy with targeted drugs, the survival of the patient was more than 6 months. As a noninvasive testing strategy, capsule endoscopy can be easily performed to support etiological diagnostic efforts in cases where other diagnostic options are lacking. Early diagnosis and therapeutic intervention can contribute to better prognostic outcomes for GMLC patients.

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.

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.

An Unusual Presentation of Duodenal Metastasis of a Previously Undiagnosed Primary Lung Adenocarcinoma

A cancer diagnosis can be a frightening experience for both patients and their families. It is at this juncture that a prompt diagnosis of cancer becomes vital. Lung cancer is the leading cause of cancer-related deaths in men and women due to its aggressive nature and widespread metastasis. A metastatic lesion leading to the diagnosis of cancer followed by identifying the primary source is not unusual. Still, it is very uncommon for cancer to present with signs and symptoms of an infectious abscess. We report a case of metastatic adenocarcinoma of the lung that presented as an abdominal abscess. This article aims to bring more awareness among the medical community to include cancer in the differential for early diagnosis of potentially lethal cancer.

Colonic Metastasis of Primary Lung Cancer

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

Early Gastrointestinal Progression to Immunotherapy in Lung Cancer: A Report of Two Cases

Intestinal and pancreatic metastases are rare and often challenging to recognize and manage. Lung cancer patients with enteric involvement usually display poor outcomes. Hyperprogression to immunotherapy represents a concern, even though there is currently no agreement on its exact definition. Gastrointestinal hyperprogression to immune checkpoint inhibitors has not been described so far. In these cases, distinguishing disease-related symptoms from immune-related adverse events may represent a diagnostic conundrum. Here, we report two cases of non-small-cell lung cancer experiencing a rapid pancreatic and colic progression to immunotherapy, respectively. While further investigations to identify biomarkers associated with hyperprogression are warranted, clinicians should be aware of the potential unusual clinical presentations of this phenomenon.

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.

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.

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.

Short- and long-term outcomes of robotic surgery for rectal cancer: a single-center retrospective cohort study

PURPOSE

This study aimed to clarify the short- and long-term outcomes of robotic surgery with or without lateral lymph node dissection (LLND) for rectal cancer at Fujita Health University Hospital, Aichi, Japan, during a self-pay period.

METHODS

We retrospectively evaluated 115 consecutive patients who underwent robotic surgery for rectal cancer between September 2009 and March 2018, with a median follow-up period of 48 months. Total mesorectal excision was completed by two certified surgeons using a da Vinci S, Si, or Xi Surgical System with an entirely robotic single-docking technique. The surgical and pathological outcomes, morbidity, and oncological results were examined.

RESULTS

Lateral lymph node dissection was performed in 26 patients (22.6%). Neither conversion to open surgery nor perioperative blood transfusion occurred. Ten patients (8.7%) experienced Clavien-Dindo grade III postoperative complications. Pathologically, both the distal and radial margins were negative in all cases. The 5-year relapse-free survival rates for stages I, II, III, and IV were 93.5%, 100%, 83.8%, and not reached, respectively.

CONCLUSIONS

Even in the period before coverage by the health insurance system, robotic surgery for rectal cancer performed by experienced surgeons was safe and technically feasible, with favorable perioperative results and long-term oncological outcomes, including rates of the relapse-free survival.

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

Introduction

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

Case presentation

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

Conclusions

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

Colonic Metastasis of Lung Adenocarcinoma: A Case Report

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