Journal List > Korean J Gastroenterol > v.59(5) > 1006956

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Hsing, Kim, Lee, Han, Lee, Chang, Choi, and Jeong: Gastrointestinal Metastasis from a Primary Adenocarcinoma of the Lung Presenting with Acute Abdominal Pain
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(5): 382-385.

Published online: 21 May 2012

DOI: https://doi.org/10.4166/kjg.2012.59.5.382

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

Chien Ter Hsing, Ha Yeon Kim, Jung Hyun Lee, Ji Sun Han, Jong Hun Lee, Jin Seok Chang, Seok Reyol Choi, Jin Sook Jeong1

Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.

1Department of Pathology, Dong-A University College of Medicine, Busan, Korea.

Correspondence to: Seok Reyol Choi, Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-103, Korea. Tel: +82-51-240-5627, Fax: +82-51-240-2087, sychoi@dau.ac.kr

Received 6 December 2010       Revised 31 January 2011       Accepted 31 January 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Lung neoplasms, Neoplasm metastasis

Figures and Tables

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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Notes

Financial support: None.

Conflict of interest: None.

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