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Banciu C, Munteanu A, Aprotosoaie A, Fabian R, Dobrescu A, Vaduva A, Fabian A, Soica I, Ivan V, Sima L. Obscure Bleeding from a Metastatic Small Bowel Tumor Diagnosed Using Motorized Spiral Enteroscopy: A Case Study and a Literature Review. Diagnostics (Basel) 2024; 14:904. [PMID: 38732318 PMCID: PMC11083520 DOI: 10.3390/diagnostics14090904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Small bowel tumors are relatively rare, representing only around 5% of all gastrointestinal neoplasms, with a progressively increasing incidence. Currently, there are no established guidelines for diagnostic approaches, screening procedures, or management strategies for small bowel tumors. We present here the case of a patient with a rare type of metastatic tumor of the small bowel originating from primary lung adenocarcinoma who presented with abdominal pain, severe iron-deficiency anemia, and melena. The initial investigations, gastroscopy and colonoscopy, failed to identify the bleeding source. The obscure bleeding source and diagnosis were achieved through power motorized spiral enteroscopy (MSE), which allowed the visualization and biopsy of the tumor. Histopathological examination established the presence of a poorly differentiated non-mucinous adenocarcinoma originating from the lung. This case is reported to provide evidence of the efficiency of MSE in the diagnosis of small bowel tumors, with the method providing higher insertion depth in a reduced amount of time.
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Affiliation(s)
- Christian Banciu
- Department of Internal Medicine IV, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania; (C.B.); (A.A.); (R.F.)
| | - Andreea Munteanu
- Department of Internal Medicine IV, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania; (C.B.); (A.A.); (R.F.)
| | - Adrian Aprotosoaie
- Department of Internal Medicine IV, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania; (C.B.); (A.A.); (R.F.)
| | - Ramona Fabian
- Department of Internal Medicine IV, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania; (C.B.); (A.A.); (R.F.)
| | - Amadeus Dobrescu
- Department of Surgery II, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania;
| | - Adrian Vaduva
- Department of Microscopic Morphology-Morphopatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- ANAPATMOL Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pathology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Antonio Fabian
- Clinical Hospital of Infectious Diseases and Pneumophysiology Dr. Victor Babeș Timișoara, 300310 Timisoara, Romania;
| | - Irina Soica
- Medical School, University College London, 74 Huntley St., London WC1E 6DE, UK;
| | - Viviana Ivan
- Department of Cardiology I, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania;
| | - Laurentiu Sima
- Department of Surgical Semiology I and Thoracic Surgery, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania;
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Small Bowel Obstruction Caused by Small Intestinal Metastasis Secondary to Esophageal Carcinoma. Case Rep Surg 2021; 2021:9728424. [PMID: 34840850 PMCID: PMC8616704 DOI: 10.1155/2021/9728424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/27/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Despite the frequent rapid spread of esophageal cancers to other organs, metastases to the small intestine are uncommon. As such, this paper describes a case of a 60-year-old male who developed a small intestinal obstruction due to metastasis from esophageal carcinoma. This patient had received radical esophagectomy for esophageal carcinoma 14 months prior to the diagnosis. Furthermore, the important role of computed tomography scans played in composing the differential diagnosis will be explored. In order to relieve the obstruction, resection of the small intestine was performed, and the patient survived six months postoperatively.
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3
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Agaimy A, Daum O, Michal M, Schmidt MW, Stoehr R, Hartmann A, Lauwers GY. Undifferentiated large cell/rhabdoid carcinoma presenting in the intestines of patients with concurrent or recent non-small cell lung cancer (NSCLC): clinicopathologic and molecular analysis of 14 cases indicates an unusual pattern of dedifferentiated metastases. Virchows Arch 2021; 479:157-167. [PMID: 33506327 PMCID: PMC8298222 DOI: 10.1007/s00428-021-03032-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
Undifferentiated carcinoma metastatic to the bowel is uncommon in surgical pathology practice and might be confused with primary gastrointestinal carcinoma, melanoma, lymphoma, and others. We present 14 cases of uni- (n = 9) or multifocal (n = 5) undifferentiated large cell/rhabdoid carcinoma presenting in the bowel of patients with concurrent (n = 9) or recent (diagnosed 1 to 25 months earlier; median, 4) non-small cell lung cancer (NSCLC). Patients were 6 females and 8 males, aged 52 to 85 years. Primary NSCLC was verified histologically in 10 cases and by imaging in 4. The undifferentiated histology was present in the lung biopsy in 4/10 patients (as sole pattern in 3 and combined with adenocarcinoma in 1) and was limited to the intestinal metastases in the remainder. PDL1 was strongly expressed in 7/9 cases (CPS: 41 to 100). Loss of at least one SWI/SNF subunit was detected in 7/13 cases (54%). SMARCA2 loss (n = 6) was most frequent and was combined with SMARCA4 loss in one case. PBRM1 loss was observed in one tumor. Successful molecular testing of 11 cases revealed BRAF mutations in 4 (3 were non-V600E variants), KRAS mutations in 3, and wildtype in 4. None had EGFR mutations. Analysis of 4 paired samples revealed concordant KRAS (2) and BRAF (1) mutations or wildtype (1). Our study indicates that undifferentiated carcinoma within the intestines of patients with concurrent/recent NSCLC represents dedifferentiated metastasis from the NSCLC. Recognition of this unusual presentation is cardinal to avoid misdiagnosis with inappropriate therapeutic and prognostic implications.
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MESH Headings
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy
- Carcinoma, Large Cell/chemistry
- Carcinoma, Large Cell/genetics
- Carcinoma, Large Cell/pathology
- Carcinoma, Non-Small-Cell Lung/chemistry
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/secondary
- Cell Dedifferentiation
- Diagnosis, Differential
- Female
- Humans
- Intestinal Neoplasms/chemistry
- Intestinal Neoplasms/genetics
- Intestinal Neoplasms/secondary
- Lung Neoplasms/chemistry
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Molecular Diagnostic Techniques
- Mutation
- Predictive Value of Tests
- Prognosis
- Rhabdoid Tumor/chemistry
- Rhabdoid Tumor/genetics
- Rhabdoid Tumor/pathology
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
| | - Ondrej Daum
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Mona W Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Robert Stoehr
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute and Departments of Pathology and Cell Biology and Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Kim MC, Jang MH, Ahn JH. Metastatic large cell carcinoma of the lung: A rare cause of acute small bowel obstruction. Thorac Cancer 2020; 11:3379-3382. [PMID: 32915519 PMCID: PMC7606013 DOI: 10.1111/1759-7714.13656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022] Open
Abstract
Here, we report a case of acute intestinal obstruction as the initial presentation of primary lung cancer in a male patient. Abdominal computed tomography (CT) showed multiple polypoid masses and regional lymphadenopathy with small bowel obstruction. The patient underwent emergency surgery for multiple luminal malignancy with mesenteric masses. According to the various clinicopathological features, the tumor was confirmed to be metastatic large cell carcinoma originating from the lung. Large masses in the left lower lobe of the lung were identified on the chest CT after emergency surgery, and non‐small cell lung cancer (NSCLC), not otherwise specified (NOS), was finally diagnosed on biopsy through bronchoscopy.
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Affiliation(s)
- Min Cheol Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Min Hye Jang
- Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea
| | - June Hong Ahn
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea
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Abstract
Small bowel tumors are rare and account for approximately 3% of all gastrointestinal tumors in the United States. The incidence of small bowel neoplasms is rising-in particular, there is a rising incidence of small bowel carcinoid tumors. This may in part be due to small bowel lesion identification in an increasing number of cross-sectional imaging studies performed for other indications as well as increased use of advanced imaging techniques to assess specifically for small bowel disease. Diagnosis is a challenge owing to nonspecific clinical manifestation, rare occurrence, and low index of clinical suspicion. Yet, various small bowel neoplasms have characteristic imaging features at CT and MRI when optimal distention of the small bowel is achieved, correlating well with features seen in gross specimens. Understanding the imaging features of small bowel neoplasms is important to improve the radiologist's ability to diagnose and characterize small bowel neoplasms. Most small bowel tumors are clinically silent for long periods, and nearly half of the benign tumors are found incidentally during surgery or at cross-sectional imaging performed for other reasons. The authors review the imaging features of common benign and malignant small bowel neoplasms to aid the radiologist in diagnosis of small bowel tumors. ©RSNA, 2020.
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Affiliation(s)
- Rahul Jasti
- From the Department of Radiology, Virginia Commonwealth University Health System, 1250 E Marshall St, Richmond, VA 23298
| | - Laura R Carucci
- From the Department of Radiology, Virginia Commonwealth University Health System, 1250 E Marshall St, Richmond, VA 23298
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O'Neill RS, Duong T, Dionela W, Rogge C, Brungs D. Pancreatitis and Biliary Obstruction Secondary to Duodenal Metastasis from Rapidly Progressing Lung Adenocarcinoma Treated with Common Bile Duct Stenting. Case Rep Oncol 2020; 13:962-967. [PMID: 32999656 PMCID: PMC7506373 DOI: 10.1159/000508745] [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] [Received: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/29/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is characterised by diffuse metastases, with common sites being the brain, liver, bones, and adrenal glands. Small bowel metastasis from NSCLC is a rare phenomenon, particularly in patients with an adenocarcinoma histology. We report the case of a 56-year-old lung adenocarcinoma patient with a duodenal metastasis diagnosed on FDG/PET-CT and confirmed on duodenal biopsy. Although initially asymptomatic, he subsequently presented with obstructive jaundice secondary to rapid local disease progression at the duodenal metastasis, requiring endoscopic intervention for biliary drainage. He was commenced on single agent pembrolizumab, with disease response on subsequent follow-up. This case highlights a rare case of gastrointestinal metastasis from NSCLC requiring endoscopic intervention due to rapid progression of the disease at the site of metastasis.
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Affiliation(s)
- Robert Sean O'Neill
- Department of Oncology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Tuan Duong
- Department of Gastroenterology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Welan Dionela
- Department of Gastroenterology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Claudia Rogge
- Department of Gastroenterology, The Wollongong Hospital, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Daniel Brungs
- Department of Oncology, The Wollongong Hospital, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Ahmed A, Nasir UM, Delle Donna P, Swantic V, Ahmed S, Lenza C. A Rare Presentation of Poorly Differentiated Lung Carcinoma with Duodenal Metastasis and Literature Review. Case Rep Gastroenterol 2020; 14:186-196. [PMID: 32399002 PMCID: PMC7204736 DOI: 10.1159/000506927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/02/2020] [Indexed: 12/29/2022] Open
Abstract
Lung cancer is a common malignancy which is frequently found to metastasize to distant sites including bone, liver, and adrenal glands. There are rare reports of metastases to the gastrointestinal (GI) tract, with the duodenum being the most uncommon. We present a rare case of a poorly differentiated lung carcinoma metastasizing to the duodenum. This case enhances the medical literature as it provides additional distinct features to the clinical and histological presentation of metastatic lung carcinoma to the GI tract. A 61-year-old male with a history of poorly differentiated lung carcinoma presented with worsening dizziness, fatigue, and early satiety. He had extensive workup done in the past for hemoptysis including a computerized tomography scan of the chest which showed a new lobulated, apical lesion and hilar lymphadenopathy. He ultimately had a transthoracic fine-needle aspiration (FNA) of the mass and was later diagnosed with poorly differentiated lung carcinoma. On examination, the patient was noted to be pale, tachycardic, and hypotensive. The patient was noted to have an acute drop in his hemoglobin requiring fluid resuscitation, multiple blood transfusions, and evaluation with an esophagogastroduodenoscopy. He was found to have an oozing ulcer in the third portion of the duodenum whose biopsies showed poorly differentiated carcinoma with areas of neuroendocrine differentiation, similar to his lung biopsy results, which was consistent with metastatic lung carcinoma.
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Affiliation(s)
- Ahmed Ahmed
- Division of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Umair M Nasir
- Division of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Paul Delle Donna
- Division of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vanessa Swantic
- Division of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Shahida Ahmed
- Division of Pathology, East Orange Department of Veteran's Affair, East Orange, New Jersey, USA
| | - Christopher Lenza
- Gastroenterology and Hepatology, East Orange Department of Veteran's Affair, East Orange, New Jersey, USA
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8
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Leung KK, Khan U, Zhang M, McCurdy JD, James PD. History of malignancy and relevant symptoms may predict a positive computed tomography enterography in obscure gastrointestinal bleeds. J Gastroenterol Hepatol 2019; 34:1511-1516. [PMID: 30965387 DOI: 10.1111/jgh.14682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 03/24/2019] [Accepted: 04/03/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM This study aimed to assess the clinical utility of computed tomography enterography (CTE) and identify factors associated with a diagnostic CTE for patients with obscure gastrointestinal bleeding (OGIB). METHODS A retrospective observational study was performed at a Canadian tertiary care center from 2005 to 2015. A total of 138 patients underwent a CTE for OGIB. Univariate and multivariate logistic regressions were performed to determine factors associated with a diagnostic CTE. A highly sensitive clinical rule was then developed to help identify OGIB patients for whom a CTE may be beneficial in their clinical work-up. RESULTS A possible bleeding source was identified in 30 (22%) cases. The presence of abdominal or constitutional symptoms as well as history of colorectal cancer was significantly associated with a positive CTE in univariate and multivariate analyses (P < 0.05). A positive CTE could be predicted based on the presence of abdominal or constitutional symptoms and history of colorectal cancer with 90% sensitivity (95% CI 74-98%) in our population. CONCLUSION CTE identified a possible source of OGIB in one in five cases. In patients with the presence of abdominal or constitutional symptoms and a personal history of colorectal cancer, CTE may contribute to their diagnostic work-up.
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Affiliation(s)
- Kristel K Leung
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Usman Khan
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Mei Zhang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey D McCurdy
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul D James
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Hu Y, Feit N, Huang Y, Xu W, Zheng S, Li X. Gastrointestinal metastasis of primary lung cancer: An analysis of 366 cases. Oncol Lett 2018; 15:9766-9776. [PMID: 29928351 PMCID: PMC6004691 DOI: 10.3892/ol.2018.8575] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/01/2017] [Indexed: 02/06/2023] Open
Abstract
The gastrointestinal (GI) tract is not a common site of metastasis in primary lung cancer. The aim of the present study was to reveal the clinical and prognostic characteristics of gastrointestinal metastases of lung cancer (GMLC). Information on 366 cases of GMLC was collected and factors that affect severe GI complications were analyzed. Univariate and multivariate survival analyses were performed using the Cox proportional hazards model. Of the cases analyzed, the small intestine (59.6%) and colorectum (25.6%) were the two organs where lung cancer was most likely to metastasize in the GI tract. Squamous cell carcinoma (28.5%), adenocarcinoma (27.6%) and large cell carcinoma (20.9%) were the three most common histological types. However, compared with the histological distributions of primary lung cancer, patients with large cell carcinoma exhibited the highest elevated risk of GMLC [relative risk (RR), 4.07; P<0.001] and those with adenocarcinoma exhibited the lowest risk (RR, 0.58; P<0.001). Differences in organ involvement and in histological type led to varying GI complications. It was also indicated that chemotherapy was associated with a decreased risk of hemorrhage (P=0.006), but there was no reduction in the risk of hemorrhage associated with perforation and obstruction (P>0.05). The median overall survival time of GMLC patients was 2.8 months (range, 0–108 months). The survival analyses revealed that perforation and extra-GI metastasis were negative prognostic factors but abdominal surgery was identified a positive prognostic factor. In conclusion, the histological distribution of GMLC differed from that of primary lung cancer. Sufficient and careful patient evaluation, targeted surgeries and systemic therapies for specific patients are able to increase patient survival rate and improve the quality of life.
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Affiliation(s)
- Yue Hu
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Noah Feit
- The Johns Hopkins University, Baltimore, MD 21231, USA
| | - Yanqin Huang
- Cancer Institute, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Wenhong Xu
- Department of Radiation Oncology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Shu Zheng
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.,Cancer Institute, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiuzhen Li
- Department of Pathology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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10
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Balla A, Subiela JD, Bollo J, Martínez C, Rodriguez Luppi C, Hernández P, Pascual-González Y, Quaresima S, Targarona EM. Gastrointestinal metastasis from primary lung cancer. Case series and systematic literature review. Cir Esp 2018; 96:184-197. [PMID: 29567360 DOI: 10.1016/j.ciresp.2017.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/14/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
Aim of the present study is to report clinical characteristics and outcomes of patients treated in authors' hospital for GI metastasis from primary lung cancer, and to report and analyse the same data concerning patients retrieved from a systematic literature review. We performed a retrospective analysis of prospectively collected data, and a systematic review using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Ninety-one patients were included, 5 patients from the authors' hospital and 86 through PubMed database using the keywords "intestinal metastasis" AND "lung cancer". The median time between primary lung cancer diagnosis and GI metastasis diagnosis was 2 months and the median overall survival was 4 months. This group of patients present a poor prognosis and the gold standard treatment is not defined. None of the reported treatments had a significant impact on survival.
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Affiliation(s)
- Andrea Balla
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España; Department of General Surgery and Surgical Specialties Paride Stefanini, Sapienza, University of Rome, Roma, Italia.
| | - José D Subiela
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Jesús Bollo
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Carmen Martínez
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Carlos Rodriguez Luppi
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Pilar Hernández
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Yuliana Pascual-González
- Servicio de Neumología, Hospital Universitario de Bellvitge, Universidad de Barcelona, Barcelona, España
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties Paride Stefanini, Sapienza, University of Rome, Roma, Italia
| | - Eduard M Targarona
- Unidad de Cirugía General y Digestiva, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
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11
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Ustaoğlu M, Koçak G, Siviloğlu Ç, Cengiz E. An unusual case of duodenal metastasis of pulmonary pleomorphic carcinoma. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:136-137. [PMID: 29391323 PMCID: PMC6322627 DOI: 10.5152/tjg.2018.17288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/07/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Müge Ustaoğlu
- Department of Gastroenterology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Gülgün Koçak
- Department of Pathology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Çiğdem Siviloğlu
- Department of Pathology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ercüment Cengiz
- Department of Medical Oncology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
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12
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Memon Z, Ferm S, Fisher C, Hassam A, Luo J, Kim SH. Rare Case of Duodenal Metastasis From Pulmonary Squamous Cell Carcinoma. J Investig Med High Impact Case Rep 2017; 5:2324709617737567. [PMID: 29124074 PMCID: PMC5661756 DOI: 10.1177/2324709617737567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/31/2017] [Accepted: 09/17/2017] [Indexed: 11/17/2022] Open
Abstract
Pulmonary squamous cell carcinoma is the second most common non-small cell malignancy of the lung. It commonly metastasizes to the adrenal glands, bone, liver, brain, and kidneys. Most occurrences of metastatic squamous cell carcinoma involving the gastrointestinal tract originate from primary lung tumors. Metastasis to the duodenum, however, is exceedingly rare, with very few cases of stomach or duodenal involvement described in the literature. We report the case of a patient with stage IV pulmonary squamous cell carcinoma metastasizing to the duodenum with an uncommon presentation to add to the paucity of literature available regarding this rare finding.
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Affiliation(s)
- Zain Memon
- Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Samson Ferm
- New York Presbyterian Queens, Queens, NY, USA
| | | | - Akil Hassam
- New York Presbyterian Queens, Queens, NY, USA
| | - Jean Luo
- New York Presbyterian Queens, Queens, NY, USA
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13
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Qasrawi A, Tolentino A, Abu Ghanimeh M, Abughanimeh O, Albadarin S. BRAF V600Q-mutated lung adenocarcinoma with duodenal metastasis and extreme leukocytosis. World J Clin Oncol 2017; 8:360-365. [PMID: 28848703 PMCID: PMC5554880 DOI: 10.5306/wjco.v8.i4.360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/11/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
Driver mutations in patients with non-small cell lung cancer (NSCLC) can lead to distinct behaviors and patterns of metastasis. Mutations in the proto-oncogene B-raf (BRAF) occur in approximately 3% of NSCLC cases. In the literature, reports of patients with lung adenocarcinomas metastasizing to the duodenum are rare, and most of the only 21 cases reported were from before the advent of next-generation sequencing. We present here a case involving a 57-year-old female who had a lytic lesion in her lesser trochanter. Biopsy showed metastatic adenocarcinoma of lung origin. Chest X-ray showed a large left upper lobe mass. Next-generation sequencing analysis confirmed the presence of BRAF V600Q mutation. The patient presented with persistent anemia and melena. Esophagogastroduodenoscopy confirmed the presence of duodenal metastasis. She also had suspected paraneoplastic leukemoid reaction. To our knowledge, this is only the second well-documented case of gastrointestinal metastasis from BRAF-mutated lung cancer.
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14
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Leduc C, Prim N, Mennecier B, Delvaux M, Gangi A, Quoix E. Diagnosis of Jejunal Metastases from Lung Cancer Using Capsule Endoscopy. Case Rep Oncol 2016; 9:526-529. [PMID: 27790115 PMCID: PMC5073535 DOI: 10.1159/000447349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/30/2016] [Indexed: 01/19/2023] Open
Abstract
Gastrointestinal metastases from lung cancer are rare and usually asymptomatic. We report a case of small bowel metastases from primary lung cancer revealed by abdominal pain and severe recurrent anaemia. The diagnosis was obtained with capsule endoscopy. This non-invasive procedure thus represents a valuable method contributing to a rapid and detailed diagnosis while reducing underdiagnosis, and it should thus be considered for lung cancer patients complaining of abdominal symptoms, which may indeed be related to gastrointestinal metastases.
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Affiliation(s)
- Charlotte Leduc
- Service de pneumologie, Pôle de Pathologie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nathalie Prim
- Service de pneumologie, Pôle de Pathologie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Bertrand Mennecier
- Service de pneumologie, Pôle de Pathologie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michel Delvaux
- Service de gastro-entérologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d'imagerie interventionnelle oncologique et viscérale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Elisabeth Quoix
- Service de pneumologie, Pôle de Pathologie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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15
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Vailati C, Dainese E, Parente F. An Unusual Case of Right Lower Abdominal Pain. Gastroenterology 2016; 151:e13-4. [PMID: 27376520 DOI: 10.1053/j.gastro.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/30/2016] [Accepted: 04/08/2016] [Indexed: 01/06/2023]
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16
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Alkhayal K. Metastatic malignant pleural mesothelioma masquerading as a case of acute abdomen secondary to small bowel perforation. Ann Saudi Med 2016; 36:229-31. [PMID: 27236396 PMCID: PMC6074537 DOI: 10.5144/0256-4947.2016.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
UNLABELLED Metastatic pleural mesothelioma is a rare disease. The present study aimed to report a rare presentation of metastatic malignant mesothelioma (MM). The patient was an elderly man who presented with small bowel (jejunal) perforation secondary to metastatic pleural mesothelioma deposits. This was a rare presentation of a rare disease and the first reported case in the published studies in which MM masqueraded as bowel perforation prior to the primary diagnosis. SIMILAR CASES PUBLISHED 1.
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Affiliation(s)
- Khayal Alkhayal
- Dr. Khayal Alkhayal, Department of Surgery,, King Saud University,, Riyadh 11472, Saudi Arabia, T: +966-11-4692800,, F: Fax: +966-11-4699353, , ORCiD ID: http://orcid.org/0000-0001-8296-808X
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17
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Linsen PVM, Linsen VMJ, Buunk G, Arnold DE, Aerts JGJV. Iron deficiency anemia as initial presentation of a non-small cell lung carcinoma: A case report. Respir Med Case Rep 2015; 16:109-11. [PMID: 26744672 PMCID: PMC4681980 DOI: 10.1016/j.rmcr.2015.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 02/07/2023] Open
Abstract
Duodenal metastases secondary to lung cancer are very rare and most of the time asymptomatic. When symptomatic they usually present with bowel obstruction or perforation. We here describe the case of a 68 year-old man with a solitary metastasis in the duodenum from a non-small cell lung carcinoma (NSCLC). The patient presented with reduced exercise tolerance and iron deficiency anemia without clinical gastrointestinal blood loss. Further investigation showed a tumor in the left upper lung lobe and a duodenal metastasis for which he received chemotherapy. To the best of our knowledge this is the first case report of iron deficiency anemia as initial presentation of a duodenal metastasis from a NSCLC.
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Affiliation(s)
| | | | - Gerba Buunk
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | | | - Joachim G J V Aerts
- Department of Pulmonology, Amphia Hospital, Breda, The Netherlands; Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
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18
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Lu B, Ding C, Wang C, Cao J. A case of small intestinal hemorrhage secondary to metastatic lung cancer in the elderly. Chin J Cancer Res 2015; 27:218-20. [PMID: 25941442 PMCID: PMC4409974 DOI: 10.3978/j.issn.1000-9604.2014.11.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/09/2014] [Indexed: 01/16/2023] Open
Abstract
Gastrointestinal metastasis from primary lung cancer is rare. In the present study, we report the case of a 78-year-old male who was admitted to the emergency department with acute bleeding of the digestive tract. During evaluation, he was found to have lung adenocarcinoma metastasis in the small bowel leading to hemorrhage. A jejunum wedge resection was carried out and bleeding was controlled. However, 2 months after the operation, the patient died from severe pulmonary infection. We also review the published literature of primary lung cancer with gastrointestinal metastasis.
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Affiliation(s)
- Bangchao Lu
- Department of Gerontology, Nanjing Drum Tower Hospital, Nanjing 210008, China
| | - Congzhu Ding
- Department of Gerontology, Nanjing Drum Tower Hospital, Nanjing 210008, China
| | - Chun Wang
- Department of Gerontology, Nanjing Drum Tower Hospital, Nanjing 210008, China
| | - Juan Cao
- Department of Gerontology, Nanjing Drum Tower Hospital, Nanjing 210008, China
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19
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Park YJ, Kim KY, Park JY, Cho JS, Kim Y, Shin SH. Generalized peritonitis arising from small bowel metastasis in a lung cancer patient. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:57-60. [PMID: 23323237 PMCID: PMC3539111 DOI: 10.4174/jkss.2013.84.1.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/24/2012] [Accepted: 10/22/2012] [Indexed: 11/30/2022]
Abstract
Symptomatic gastrointestinal metastasis from lung malignancy is rarely reported. In this report, we present a case of lung adenocarcinoma with acute abdominal pain from small bowel perforation. The patient underwent small bowel resection and the final diagnosis was metastatic adenocarcinoma originating from lung. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7 (CK7), and negative for CK20. We present this rare case and briefly review the literature.
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Affiliation(s)
- Young Joo Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
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20
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Song Y, Li M, Shan J, Ye X, Tang S, Fang X, Ding K, Yuan Y. Acute small bowel obstruction: a rare initial presentation for the metastasis of the large-cell carcinoma of the lung. World J Surg Oncol 2012; 10:26. [PMID: 22284720 PMCID: PMC3283520 DOI: 10.1186/1477-7819-10-26] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 01/29/2012] [Indexed: 12/15/2022] Open
Abstract
We present one case with symptom of paroxysmal abdominal pain for over 20 days. Abdominal computerized tomography (CT) scan revealed intestinal obstruction and a mass of 6.0 cm × 6.0 cm in size located at the left adrenal. Chest CT scan showed a lobulated mass of 2.7 cm × 2.7 cm in size at the upper left lung. Core needle biopsy of the lung mass confirmed the diagnosis of large cell carcinoma. The patient underwent an emergency abdominal laparotomy and received a chemotherapy regimen that consisted of pemetrexed and cisplatin postoperatively. In addition, we made a review of the literature of the occurrence, diagnosis and outcome of this manifestation.
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Affiliation(s)
- Yongmao Song
- Department of Surgical Oncology, the 2nd Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310009, P.R. China
| | - Modan Li
- Department of Medical Oncology, the 2nd Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310009, P.R. China
| | - Jianzhen Shan
- Department of Medical Oncology, the 2nd Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310009, P.R. China
| | - Xiaoxian Ye
- Department of Medical Oncology, the 2nd Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310009, P.R. China
| | - Shangyi Tang
- Department of Medical Oncology, the 2nd Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310009, P.R. China
| | - Xuefeng Fang
- Department of Medical Oncology, the 2nd Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310009, P.R. China
| | - Kefeng Ding
- Department of Surgical Oncology, the 2nd Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310009, P.R. China
| | - Ying Yuan
- Department of Medical Oncology, the 2nd Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310009, P.R. China
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21
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Intussusception in adults: what radiologists should know. Emerg Radiol 2011; 19:89-101. [PMID: 22200965 DOI: 10.1007/s10140-011-1006-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 11/22/2011] [Indexed: 12/14/2022]
Abstract
Adult intussusception (AI) is a rare entity with an organic lesion within the intussusception in 70-90% of the cases. Intussusception is classified according to location, etiology, and to the presence or not of a lead point. We illustrate several causes of AI with a variety of radiological findings on plain film, ultrasonography, computed tomography, magnetic resonance, and endoscopy seen at our institution. Imaging plays a major role in their diagnosis and in determining the appropriate treatment.
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22
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Hautefeuille G, Reignier S, Rudler M. An unusual cause of gastrointestinal bleeding. Gastroenterology 2011; 140:e5-6. [PMID: 21457710 DOI: 10.1053/j.gastro.2010.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 03/07/2010] [Accepted: 03/19/2010] [Indexed: 12/02/2022]
Affiliation(s)
- Gaëlle Hautefeuille
- Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
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23
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Wang Y, An T, Yang L, Wang Z, Zhuo M, Duan J, Wang J, Wu M. [Primary lung cancer with gastrointestinal metastasis: 2 case report and literature review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:278-80. [PMID: 21426674 PMCID: PMC5999648 DOI: 10.3779/j.issn.1009-3419.2011.03.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Gastrointestinal metastasis unusually occurs in primary lung cancer instead of lung, liver, brain, bone and adrenal. Recently, we has treated two patients with primary lung cancer metastasized to gastrointestinal system consequently. This paper will conduct the diagnosis, treatment and follow-up report and review related literature in order to deepen the understanding of rarely metastases of lung cancer to avoid misdiagnosis and missed diagnosis.
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Affiliation(s)
- Yuyan Wang
- Department of Thoracic Oncology, Beijing Cancer Hospital, Beijing University Oncology College, Beijing, China
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24
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[Prevalent intestinal metastasis revealing bronchial carcinoma]. ACTA ACUST UNITED AC 2010; 34:415-6. [PMID: 20219306 DOI: 10.1016/j.gcb.2009.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 12/17/2009] [Accepted: 12/24/2009] [Indexed: 11/23/2022]
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25
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Goh BKP, Yeo AWY, Koong HN, Ooi LLPJ, Wong WK. Laparotomy for acute complications of gastrointestinal metastases from lung cancer: is it a worthwhile or futile effort? Surg Today 2007; 37:370-4. [PMID: 17468816 DOI: 10.1007/s00595-006-3419-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 11/24/2006] [Indexed: 02/07/2023]
Abstract
PURPOSE Complications of gastrointestinal tract (GIT) metastases from lung cancer are rare and the optimal management remains controversial. Whereas some authors advocate a nonoperative policy due to the poor prognosis, others recommend aggressive surgery as it offers effective palliation. The aim of this study is to present our experience with nine patients who underwent a laparotomy for complications of GIT metastases and to determine their outcome. METHODS Between 1995 and 2005, nine patients who underwent a laparotomy for complications of pathologically proven GIT metastases secondary to lung cancer were retrospectively reviewed. RESULTS All patients were male with a median age of 63 years (range, 40-70 years) at initial presentation. The sites of symptomatic GIT metastases include the ileum (n = 3), jejunum (n = 3), cecum (n = 1), duodenum (n = 2) and stomach (n = 2) and the patients presented with obstruction (n = 2), hemorrhage (n = 3), intussusception (n = 3) and perforation (n = 1). The median time of symptomatic GIT metastases from initial presentation was 2 months (range, 0-8 months) and the histological subtypes of the lung cancer were squamous cell carcinoma (n = 3), large cell carcinoma (n = 3), adenocarcinoma (n = 1), pleomorphic carcinoma (n = 1) and pleomorphic with adenocarcinoma (n = 1). All patients underwent an exploratory laparotomy and the definitive surgical procedure was dependent on the site and extent of disease. These included a small bowel resection with primary anastomosis (n = 5), a subtotal gastrectomy with an extended right hemicolectomy (n = 1), a gastrojejunostomy (n = 1), a right hemicolectomy (n = 1), and an ulcerectomy with under-running of ulcers (n = 1). Eight of the nine patients (89%) recovered from surgery and were then discharged from hospital at a median time of 9.5 days (range, 6-24 days). All these eight patients survived for more than 30 days and the median survival was 6 months (range, 2-13 months). Four of the 8 patients (50%) lived for more than 6 months and all eight patients died of advanced metastatic lung cancer with multiple sites of metastases at the time of death. CONCLUSION Gastrointestinal tract metastases should always be considered in the differential diagnosis of lung cancer patients presenting with an acute abdomen. Aggressive surgical treatment is worthwhile in a selected group of patients as it provides effective palliation.
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Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608
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26
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Kostakou C, Khaldi L, Flossos A, Kapsoritakis AN, Potamianos SP. Melena: A rare complication of duodenal metastases from primary carcinoma of the lung. World J Gastroenterol 2007; 13:1282-5. [PMID: 17451216 PMCID: PMC4147010 DOI: 10.3748/wjg.v13.i8.1282] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Small bowel metastases from primary carcinoma of the lung are very uncommon and occur usually in patients with terminal stage disease. These metastases are usually asymptomatic, but may present as perforation, obstruction, malabsorption, or hemorrhage. Hemorrhage as a first presentation of small bowel metastases is extremely rare and is related to very poor patient survival. We describe a case of a 61- year old patient with primary adenocarcinoma of the lung, presenting with melena as the first manifestation of small bowel metastasis. Both primary tumor and metastatic lesions were diagnosed almost simultaneously. Upper gastrointestinal endoscopy performed with a colonoscope revealed active bleeding from a metastatic tumor involving the duodenum and the proximal jejunum. Histological examination and immunohistochemical staining of the biopsy specimen strongly supported the diagnosis of metastatic lung adenocarcinoma, suggesting that small bowel metastases from primary carcinoma of the lung occur usually in patients with terminal disease and rarely produce symptoms. Gastrointestinal bleeding from metastatic small intestinal lesions should be included in the differential diagnosis of gastrointestinal blood loss in a patient with a known bronchogenic tumor.
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Affiliation(s)
- Chrysoula Kostakou
- Department of Gastroenterology, University Hospital of Larissa 41447, Greece
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