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Yoo, Sim, Lee, Shim, Chang, Kim, and Sung: A Case of Duodenal Metastasis from Adenocarcinoma of the Lung
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(3): 283-288.

Published online: 30 September 2007

DOI: https://doi.org/10.4046/trd.2007.63.3.283

A Case of Duodenal Metastasis from Adenocarcinoma of the Lung

Seung Hyun Yoo, M.D.1, Yun Su Sim, M.D.1, Jin Hwa Lee, M.D.1, Ki Nam Shim, M.D.1, Jung Hyun Chang, M.D.1, Yoon Kyung Kim, M.D.2, Sun Hee Sung, M.D.3

1Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

2Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea.

3Department of Pathology, Ewha Womans University School of Medicine, Seoul, Korea.

Address for correspondence: Jin Hwa Lee, M.D. Department of Internal Medicine, Ewha Womans University School of Medicine 911-1 Mok-dong, Yancheon-gu, Seoul 158-710, Korea. Phone: 82-2-2650-6007, Fax: 82-2-2655-2076, jinhwalee@ewha.ac.kr

Received 9 July 2007       Accepted 13 August 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

A gastrointestinal metastasis from lung cancer is rare and is quite often found during an autopsy. A 58-year-old man was admitted with left upper back pain and a mass in the left upper lobe on the chest radiograph. The transbronchial lung biopsy revealed an adenocarcinoma of the lung. A gastroduodenoscopy was carried out to evaluate the indigestion and epigastric discomfort. The duodenofibroscopy revealed bulging mucosa on the minor papilla of the duodenum. A metastasis to the duodenum from an adenocarcinoma of the lung was diagnosed by a duodenofibroscopic biopsy of the bulging lesion. We report this rare case of an adenocarcinoma of lung with a metastasis to the duodenum.

Keywords: Lung cancer, Duodenal metastasis, Adenocarcinoma

Figures and Tables

Figure 1
Chest radiograph shows increased radioopacities in left upper lobe and left hilar area.
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Figure 2
Computed tomogram of the chest shows a 4.7 cm-sized mass in the left upper lobe with invasion of chest wall including left 3rd rib (A) and an about 6.3-cm sized conglomerated mass in the left hilar area (B).
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Figure 3
F18-FDG positron emission tomogram of whole body shows a large intense FDG-uptaked mass in left upper lung (SUV max 17.7), intense hypermetabolic lymphadenopathy at left hilar, aortopulmonary window, paraaortic, highest mediastinum, and supraclavicular area. A large hypermetabolic mass in the left adrenal gland and a focal increased FDG uptake at the right axilla were also noted.
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Figure 4
Bronchoscopy shows extrinsic compression around the orifice of apicoposterior segmental bronchus of the left upper lobe
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Figure 5
Gastroduodenoscopy shows bulging mucosa on the minor papilla of the duodenum.
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Figure 6
(A) Transbronchial lung biopsy shows adenocarcinoma. (H&E, ×100) (B) Gastroduodenoscopic biopsy of the duodenum shows stromal infiltration of markedly atypical epithelial cells, consistent with adenocarcinma. (H&E, ×100) (C) Cancer tissue of the duodenum shows positive immunostaining for thyroid transcription factor-1 (TTF-1) for differentiating pulmonary adenocarcinoma from non-pulmonary adenocarcinoma. (TTF-1 stain, ×100)
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