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Li Y, Xu Y, Cai S, Li J, Ruan F, Xia C, Luo P, Li J. Combination of microwave ablation and systemic treatments achieve a long survival time for a patient with metachronous advanced double primary lung and colon adenocarcinoma: A case report. Oncol Lett 2024; 28:407. [PMID: 38988445 PMCID: PMC11234812 DOI: 10.3892/ol.2024.14540] [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: 07/27/2023] [Accepted: 03/07/2024] [Indexed: 07/12/2024] Open
Abstract
Despite significant improvements that have been made in terms of progression-free survival and overall survival rates brought about by targeted therapy in non-small cell lung cancer (NSCLC), the emergence of drug resistance remains a limiting factor. However, a previous study has shown promising results by combining local microwave ablation (MWA) with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy for patients with oligometastatic NSCLC. The current study presented the case of a Chinese female patient who was identified as having lung adenocarcinoma (LADC) with EGFR exon 19 deletions (Del) in January 2014, and who experienced multiple instances of oligoprogression but showed a positive response to a combination of chemotherapy, MWA and a TKI drug. First, the patient was treated with four cycles of chemotherapy (120 mg docetaxel on day 1 and 40 mg cisplatin on days 1, 2 and 3; every three weeks as one cycle) and gefitinib (Iressa; 250 mg/day), maintaining a partial response for 17 months. In August 2015, a new solitary lesion was identified in the right lung and erlotinib (Tarceva; 150 mg/day) was administered for 3 months thereafter. In response, the patient underwent ablation of both the new right lung lesion and the primary left lung lesion in January 2016. Subsequently, a treatment course consisting of six cycles of chemotherapy (0.8 g pemetrexed on day 1 and 70 mg nedaplatin on days 1 and 2; every three weeks as one cycle) resulted in stable disease. In May 2016, the patient began treatment with osimertinib (AZD9291; 80 mg/day), resulting in a rapid shrinkage of the mediastinal lymph node after one month, which has been providing a benefit for the patient for 82 months and counting. Of note, the patient also developed metachronous colon cancer in January 2020, followed by the identification of right posterior liver metastases in February 2020 and lung metastases in May 2021 and in February 2022. To address this, the patient underwent radical resection of colon cancer and liver metastasectomy and received a combination of chemotherapy with bevacizumab, along with MWA for lung metastases. Remarkably, the patient has achieved long-term survival of 110 months. In conclusion, this case highlights the promising potential of combining MWA with systemic therapy for a patient with advanced LADC harboring EGFR exon 19 Del and metachronous lung and liver-metastasized colon adenocarcinoma. MWA effectively controlled both in situ oligoprogression and new oligoprogression, thereby enhancing the efficacy of systematic chemotherapy/TKI therapy. Furthermore, this case report emphasizes the importance of repeated histologic biopsies and genetic testing as reliable indicators for adjusting treatment regimens. Physicians should also remain vigilant regarding the occurrence of secondary primary carcinomas, and timely and accurate adjustments to treatment plans will be of significant benefit to patients in terms of treatment efficacy and overall quality of life.
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Affiliation(s)
- Yun Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Yali Xu
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Shifeng Cai
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Jingwen Li
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Fangying Ruan
- Zhejiang Shaoxing Topgen Biomedical Technology Co., Ltd., Shanghai 201321, P.R. China
| | - Chaoran Xia
- Zhejiang Shaoxing Topgen Biomedical Technology Co., Ltd., Shanghai 201321, P.R. China
| | - Peng Luo
- Zhejiang Shaoxing Topgen Biomedical Technology Co., Ltd., Shanghai 201321, P.R. China
| | - Jun Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
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Nakayama Y, Yamaguchi M, Inoue K, Hamaguchi S, Tajima Y. Successful resection of colonic metastasis of lung cancer after colonic stent placement: A case report and review of the literature. World J Gastrointest Surg 2023; 15:1549-1558. [PMID: 37555118 PMCID: PMC10405118 DOI: 10.4240/wjgs.v15.i7.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 07/21/2023] Open
Abstract
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.
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Affiliation(s)
- Yoko Nakayama
- Department of Surgery, Oda Municipal Hospital, Oda 694-0063, Shimane, Japan
| | - Minekazu Yamaguchi
- Department of General Medicine, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
| | - Keisuke Inoue
- Department of Surgery, Oda Municipal Hospital, Oda 694-0063, Shimane, Japan
| | - Shunichi Hamaguchi
- Department of General Medicine, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
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Zhong Y, Tang X, Deng B. Capsule Endoscopy-Based Diagnosis of Lung Squamous Cell Carcinoma Associated with Abdominal Pain and Metastasis to Small Intestine: A Case Report. Case Rep Oncol 2023; 16:102-108. [PMID: 36824988 PMCID: PMC9941851 DOI: 10.1159/000529060] [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: 09/28/2022] [Accepted: 01/02/2023] [Indexed: 02/22/2023] Open
Abstract
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.
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Affiliation(s)
- Yihua Zhong
- Department of Gastroenterology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xianjun Tang
- Breast Cancer Center, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Bowen Deng
- Department of Gastroenterology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
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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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Chen HF, Zhang QX, Zhu YC, Du KQ, Li XF, Wu LX, Wang WX, Xu CW. Intestinal metastasis from primary ROS1-positive lung adenocarcinoma cancer patients responding to crizotinib. Onco Targets Ther 2018; 11:7821-7825. [PMID: 30464529 PMCID: PMC6225853 DOI: 10.2147/ott.s178985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Small intestinal metastases from primary lung cancer are rare. Such patients have a poor prognosis. Early diagnosis of small intestinal metastases is difficult because of the low incidence of clinically apparent symptoms. The standard treatment for small intestinal metastases has not been established. A 69-year-old Chinese man presented for evaluation of a tumor in the right lower lung and mediastinal lymph node enlargement on clinical examination. The clinical stage was cT2N2M0 (stage IIIA). Histologic examination of the tumor revealed lung adenocarcinoma. He could not tolerate surgery; hence, he received two chemotherapy regimens. However, the disease progressed. He had bloating after chemotherapy and decreased flatus. An abdominal CT scan showed an intestinal effusion with local intestinal obstruction. Medical treatment was ineffective; hence, he underwent a diagnostic laparoscopy. The pathologic evaluation suggested an intestinal metastatic adenocarcinoma from the primary lung cancer. Based on an real-time PCR assay, the tumor had a ROS1 fusion and responded well to crizotinib. The progression-free survival was 7 months. Physicians must be aware of the possibility of intestinal metastases from primary lung cancer. With an accurate diagnosis and thorough evaluation, patients may benefit from targeted therapy.
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Affiliation(s)
- Hua-Fei Chen
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China
| | - Qu-Xia Zhang
- Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China,
| | - You-Cai Zhu
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China
| | - Kai-Qi Du
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China
| | - Xiao-Feng Li
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China
| | - Li-Xin Wu
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China
| | - Wen-Xian Wang
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China,
| | - Chun-Wei Xu
- Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China,
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Bhardwaj R, Bhardwaj G, Gautam A, Karagozian R. Upper Gastrointestinal Bleed as a Manifestation of Poorly Differentiated Metastatic Squamous Cell Carcinoma of the Lung. J Clin Diagn Res 2017; 11:OD13-OD14. [PMID: 28764229 DOI: 10.7860/jcdr/2017/27040.10090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/15/2017] [Indexed: 11/24/2022]
Abstract
Gastrointestinal (GI) metastasis from primary lung cancer is a rare clinical finding. Lung cancer most often metastasizes to the brain, bone, liver, and adrenal glands; with gastrointestinal involvement being very rare. We report a case of a 39-year-old female with a diagnosis of poorly differentiated Squamous Cell Carcinoma (SCC) of the lung presenting with dizziness and melena. Esophagogastroduodenoscopy (EGD) showed a bleeding mass in the stomach. Final biopsy report and Immunohistochemistry (IHC) of the specimen were consistent with SCC lung metastasis. While it is imperative to have a high clinical suspicion for GI metastasis in patients with primary lung cancer presenting with GI symptoms, it may be challenging to establish diagnosis. Endoscopy along with pathology and immunohistochemistry play a crucial role in differentiating primary GI malignancies from metastasis.
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Affiliation(s)
- Richa Bhardwaj
- Resident, Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Gaurav Bhardwaj
- Research Student, Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Arun Gautam
- Resident, Department of Internal Medicine, University of Connecticut, Hartford, Connecticut, USA
| | - Raffi Karagozian
- Attending Physician, Department of Gastroenterology and Hepatology, University of Connecticut, Farmington, Connecticut, USA
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7
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Chen CH, Chen WM, Tung SY, Wu CS, Tong WL, Lee KF, Wei KL. Gastrointestinal metastasis from primary sarcomatoid carcinoma of the lung: a case report and review of the literature. World J Surg Oncol 2015; 13:174. [PMID: 25947890 PMCID: PMC4440284 DOI: 10.1186/s12957-015-0599-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/28/2015] [Indexed: 12/30/2022] Open
Abstract
Gastrointestinal metastases in lung cancer are extremely rare. The report presents a rare case of primary lung sarcomatoid carcinoma with both gastric and colonic metastases, and reviews the literature about endoscopic presentation of colonic metastases.
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Affiliation(s)
- Chun-Hsien Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, 6 Section West, Chia-Po Road, Putz City, Chia-Yi, 613, Taiwan. .,Current address: Chun-Hsien Chen, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, 6 Section West, Chia-Po Road, Putz City, Chia-Yi, 613, Taiwan.
| | - Wei-Ming Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, 6 Section West, Chia-Po Road, Putz City, Chia-Yi, 613, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Shui-Yi Tung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, 6 Section West, Chia-Po Road, Putz City, Chia-Yi, 613, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Cheng-Shyong Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, 6 Section West, Chia-Po Road, Putz City, Chia-Yi, 613, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wei-Lin Tong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, 6 Section West, Chia-Po Road, Putz City, Chia-Yi, 613, Taiwan.
| | - Kam-Fai Lee
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, 6 Section West, Chia-Po Road, Putz City, Chia-Yi, 613, Taiwan.
| | - Kuo-Liang Wei
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, 6 Section West, Chia-Po Road, Putz City, Chia-Yi, 613, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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