A Rare Presentation of Poorly Differentiated Lung Carcinoma with Duodenal Metastasis and Literature Review

Abstract

Lung cancer is a common malignancy which is frequently found to metastasize to distant sites including bone, liver, and adrenal glands. There are rare reports of metastases to the gastrointestinal (GI) tract, with the duodenum being the most uncommon. We present a rare case of a poorly differentiated lung carcinoma metastasizing to the duodenum. This case enhances the medical literature as it provides additional distinct features to the clinical and histological presentation of metastatic lung carcinoma to the GI tract. A 61-year-old male with a history of poorly differentiated lung carcinoma presented with worsening dizziness, fatigue, and early satiety. He had extensive workup done in the past for hemoptysis including a computerized tomography scan of the chest which showed a new lobulated, apical lesion and hilar Case Ahmed et al.: Poorly Differentiated Lung Carcinoma Metastasis to the Duodenum 187lymphadenopathy. He ultimately had a transthoracic fine-needle aspiration (FNA) of the mass and was later diagnosed with poorly differentiated lung carcinoma. On examination, the patient was noted to be pale, tachycardic, and hypotensive. The patient was noted to have an acute drop in his hemoglobin requiring fluid resuscitation, multiple blood transfusions, and evaluation with an esophagogastroduodenoscopy. He was found to have an oozing ulcer in the third portion of the duodenum whose biopsies showed poorly differentiated carcinoma with areas of neuroendocrine differentiation, similar to his lung biopsy results, which was consistent with metastatic lung carcinoma.

Upper gastrointestinal haemorrhage caused by duodenal metastasis from primary lung cancer: A case report

“… 4 Although any tumour cell type of lung cancer can develop gastrointestinal metastases, the most common type is a squamous cell, followed by a large cell, and then adenocarcinoma. 5 Among small bowel metastasis, the jejunum is the most frequent site of involvement (50.9%), followed by the ileum (33.3%) and the duodenum (15.8%). 6 Duodenal metastases from lung cancer are unusual.…”

“…Moreover, capsule endoscopy is more effective in detecting small bowel abnormalities when compared to push enteroscopy. 5 In addition to the endoscopic examination, immunohistochemical (IHC) staining and histological analysis are keys to the diagnosis. It is often necessary to differentiate between different carcinomas or to distinguish a primary tumour from a metastatic tumour.…”

An Acute Jejunojejunal Intussusception Revealing a Metastatic Combined Lung Cancer

“…A higher prevalence of 4.7-14% was described in other autopsy studies. The jejunum represents the most common site followed by the ileum then the duodenum [6,7].…”

Metástasis gastrointestinales secundarias a adenocarcinoma invasivo pulmonar en un paciente joven: a propósito de un caso

“…8,9 Llegan a producir síntomas cuando ya han invadido la totalidad de la pared gástrica o intestinal; es un tumor de crecimiento rápido que ocluye la luz endoluminal, pudiendo desarrollar síntomas de obstrucción intestinal, aunque es más común encontrar que debuten como una perforación de víscera hueca por la necrosis central que se produce. [10][11][12] El sangrado digestivo producto de una metástasis de un cáncer de pulmón es muy raro. [4][5][6] Las manifestaciones clínicas más frecuentes cuando hay compromiso del tracto gastrointestinal suelen ser dolor abdominal crónico en el epigastrio y sangrado crónico debido a melena y anemia.…”