Korean J Gastroenterol.  2012 May;59(5):382-385. 10.4166/kjg.2012.59.5.382.

Gastrointestinal Metastasis from a Primary Adenocarcinoma of the Lung Presenting with Acute Abdominal Pain

• Hsing CT
• Kim HY
• Lee JH
• Han JS
• Lee JH
• Chang JS
• Choi SR
• Jeong JS

• KMID: 1792839
• DOI: http://doi.org/10.4166/kjg.2012.59.5.382

Abstract

Symptomatic gastro-intestinal metastasis in lung cancer is extremely rare and only a few case reports have been published. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain, nausea and vomiting due to duodenum, jejunum, and colon obstruction by the gastro-intestinal metastasis. The patient underwent colonoscopy and the pathologic report was adenocarcinoma. When there are similar histologic findings in both colon and pulmonary lesion, the question is whether both lesions are primary cancer or the colon lesions are metastases from lung cancer. Microscopic examination of a conventional pathologic section was not sufficient to make this determination. Immunohistochemistry was positive for thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20) and caudal-related homeobox transcription factor-2 (CDX-2) on colon mucosa specimen. Accordingly, we used immunohistochemical marker for differential diagnosis of primary adenocarcinoma of the lung with gastro-intestinal metastasis.

Keyword

Lung neoplasms; Neoplasm metastasis

MeSH Terms

*Abdominal Pain
Adenocarcinoma/*diagnosis/pathology
Colonoscopy
Diagnosis, Differential
Gastrointestinal Neoplasms/*pathology/secondary
Homeodomain Proteins/metabolism
Humans
Immunohistochemistry
Keratin-20/metabolism
Keratin-7/metabolism
Lung Neoplasms/*diagnosis/pathology
Male
Middle Aged
Nuclear Proteins/metabolism
Tomography, X-Ray Computed
Transcription Factors/metabolism

Figure

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  Fig. 1 Chest CT scan showing a high-density mass in the right upper lung region.

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  Fig. 2 Abdomen and pelvic CT scans. (A) Duodenal 2nd portion stricture and proximal portion dilation. (B) Segmental wall thickening with paracolic fat infiltration of the proximal transverse colon.

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  Fig. 3 Endoscopic findings. (A) There was an 1 cm sized nodule at the proximal descending colon which looked like a submucosal tumor with mucosal bridge. (B) Ulceroinfiltrating lesion with spontaneous bleeding in the proximal ascending colon.

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  Fig. 4 Histological findings. (A) The colon mucosa showed infiltration of poorly differentiated adenocarcinoma under the eroded mucosa, invading submucosa (H&E, ×100). (B) The malignant cells showed CK7+ suggesting not primary colon origin (Immunohistochemical stain, ×100), and (C) TTF-1+, suggesting lung cancer origin (Immunohistochemical stain, ×100). CK, cytokeratin; TTF, thyroid transcription factor.

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