Tuberc Respir Dis TRD Tuberculosis and Respiratory Diseases 1738-3536 2005-6184 The Korean Academy of Tuberculosis and Respiratory Diseases 10.4046/trd.2009.66.1.52 Case Report Gastric Metastasis of Primary Lung Adenocarcinoma Mistaken for Primary Gastric Cancer Park Young Sik M.D. 1 Lee Jin Woo M.D. 1 Lim Hyo-Jeong M.D. 1 Lee Geon Kook M.D. Ph.D. 2 Hwangbo Bin M.D. 2 Lee Hee Seok M.D. 2 Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea. Center for Lung Cancer, National Cancer Center, Goyang, Korea. Address for correspondence: Hee Seok Lee, M.D. Center for Lung Cancer, National Cancer Center, 809, Madu 1-dong, Ilsan-gu, Goyang 410-769, Korea. Phone: 82-31-920-1749, Fax: 82-31-920-1520, jekyde@yahoo.co.kr 01 2009 31 01 2009 66 1 52 57 12 10 2008 05 11 2008 Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved. 2009

The stomach is a rare site for metastasis, with autopsy incidence rates of 0.2% to 1.7%. This low rate makes diagnosis of metastatic gastric cancer challenging for clinicians. The authors report a case of a 64-year-old man diagnosed with gastric metastasis of primary lung adenocarcinoma that was initially mistaken for primary gastric cancer, as well as a review of the medical literature.

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Initial gastrofiberscopy showed 3.2 cm sized polypoid mass with ulceration in the body of stomach.

(A) Chest X-ray taken during the admission for gastrectomy showed a ground-glass opacity (GGO) lesion in the right upper lobe. (B) CT scan taken 2 months after subtotal gastrectomy showed a GGO lesion with solid portion in the right upper lobe. (C, D) Chest X-ray and CT scan taken 11 months after right upper lobectomy showed a mass with surrounding ground-glass opacity in the left lower lobe.

(A) Hematoxylin and eosin (H&E) stain in the lung tissue obtained by percutaneous needle biopsy (×100). A papillary pattern and undifferentiated diffuse proliferation, suggesting poorly differentiated adenocarcinoma are observed. (B) Immunohistochemical stain for thyroid transcription factor-1 (TTF-1) in the lung tissue obtained by percutaneous needle biopsy (×100). The strong positive staining with TTF-1 is observed. (C) H&E stain in the gastrectomy specimen (×100). The tumor cells of stomach are similar to the adenocarcinoma observed in the lung tissue. (D) Immunohistochemical stain for TTF-1 in the gastrectomy specimen (×100). The strong positive staining with TTF-1 is observed.

Gastric metastases listed by their primary sites

*One case of duodenal metastasis from osteogenic sarcoma was excluded in the table, †Three cases of duodenal metastasis from renal transitional cell carcinoma (2 cases) and colon cancer (1 case) were excluded in the table.