LETTERS TO THE EDITOR

 

Colonic metastases from non-small cell lung cancer

Metástasis de colón de un cáncer pulmonar de células pequeñas

 

 

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Key words: Colon. Lung cancer. Metastases

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Dear Editor,

Metastatic colon disease from lung cancer is considered quite rare (1,2). We report a case of colonic metastatic disease from non-small cell lung cancer, presenting with unusual clinical aspects.

 

Case report

A 68-year-old man, heavy smoker, was admitted due a four month history of low back pain, weight loss, fatigue, and worsening constipation. Physical examination was unremarkable. Laboratory studies showed mild anemia and a standard chest X-ray was normal. A spine NMR demonstrated several lytic lesions suggesting metastatic disease. Upper panendoscopy was normal; colonoscopy revealed multiple ulcerate polyps throughout the colon (Fig. 1A). Histology showed poorly differentiated cancer (Fig. 1B); immunohistochemical assessment was positive for cytokeratin 7 and TTF1 (Fig. 1 C and D), suggesting metastatic disease from non-small cell lung cancer (3). Chest and abdomen CT scan revealed a 18 mm diameter nodule in the right lower lobe. A FDG-PET/CT scan confirmed increased activity at the target lesion. A brain CT scan showed diffuse brain metastasis, and radiotherapy was started. The patient died after 5 weeks due to tumour progression.

 

Old autopsy series report an incidence of gastrointestinal metastases from lung cancer between 11 and 14% (4-6) but intra-abdominal metastases rarely display clinical manifestations (7,8). Large bowel involvement represents rarer subgroup, with symptoms being more frequent compared to patients with small intestine metastases.

 

Discussion

Metastatic bowel cancer may be difficult to distinguish from lung cancer, but positivity for cytokeratin 7 with negative cytokeratin 20 (as in our patient) favours lung cancer, whereas the reverse pattern is more consistent with colon cancer (9,10).

Symptoms of intestinal metastases depend manly on the site: usually, pain is the most common symptom when the distal gastro-intestinal system is involved, but clinical manifestations are usually not specific and may simulate a primary gastrointestinal tumour. Thus, when multiple neoplastic localization is found in the gastrointestinal tract, is probably always wise to look for other sites, not forgetting the unusual ones. This could (hopefully) lead to a better therapeutic approach and, possibly, effective or palliative treatment.

 

Chiara Bennati¹, Giuseppe Russo², Rita Chiari¹, Paolo Giovenali³ and Gabrio Bassotti^2
1Medical Oncology Section. Ospedale Santa Maria della Misericordia. San Sisto, Perugia. Italy.
²Gastroenterology & Hepatology Section. Department of Clinical & Experimental Medicine. University of Perugia. Italy.
³Diagnostic Cytology and Histology Unit. Ospedale Santa Maria della Misericordia. San Sisto, Perugia. Italy

 

References

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2. Kim SY, Ha HK, Park SW, Kang J, Kim KW, Lee SS, et al. Gastrointestinal metastasis from primary lung cancer: CT findings and clinicopathologic features. AJR Am J Roentgenol 2009,193:W197-201.         [ Links ]

3. Kerr KM. Personalized medicine for lung cancer: new challenges for pathology. Histopathology 2012;60:531-46.         [ Links ]

4. McNeill PM, Wagman LD, Neifeld JP. Small bowel metastases from primary carcinoma of the lung. Cancer 1987;59:1486-9.         [ Links ]

5. Burbige EJ, Radigan JJ, Belber JP. Metastatic lung carcinoma involving the gastrointestinal tract. Am J Gastroenterol 1980;74:504-6.         [ Links ]

6. Antler AS, Ough Y, Pitchumoni CS, Cavidian M, Thelmo W. Gastrointestinal metastases form malignant tumors of the lung. Cancer 1982; 49:70-2.         [ Links ]

7. Kabwa L, Mattei JP, Noël JP. Intestinal metastases of bronchopulmonary cancer. A propos of a case. J Chir (Paris) 1996;133:290-3.         [ Links ]

8. Hillenbrand A, Sträter J, Henne-Bruns D. Frequency, symptoms and outcome of intestinal metastases of bronchopulmonary cancer. Case report and review of the literature. Int Semin Surg Oncol 2005;2:13.         [ Links ]

9. Alkalay I, Fairfax CW 2nd, Bullard JC. Lymphangitic carcinomatosis of the lungs with normal appearing chest x-ray films. Chest 1972;62:229-30.         [ Links ]

10. Galsky M, Darling M, Hecht J, Salgia R. Case 1: small bowel obstruction due to metastatic lung cancer. J Clin Oncol 2000;18:227-8.         [ Links ]