Analysis of gastrointestinal metastasis of primary lung cancer: Clinical characteristics and prognosis

Taira, Naohiro; Kawabata, Tsutomu; Gabe, Atsushi; Furugen, Tomonori; Ichi, Takaharu; Kushi, Kazuaki; Yohena, Tomofumi; Kawasaki, Hidenori; Higuchi, Daisuke; Chibana, Kenji; Fujita, Kaori; Nakamoto, Atsushi; Owan, Isoko; Kuba, Mutsuo; Ishikawa, Kiyoshi

doi:10.3892/ol.2017.6382

Cited by 40 publications

(37 citation statements)

References 27 publications

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“…However, in our study, adenocarcinoma was the most frequent type resulting in gastrointestinal metastases. Consistent with our observations, some clinical studies [22,25,26] have shown that adenocarcinoma and squamous cell carcinoma were the most common histological types causing gastrointestinal metastases.…”

Section: Discussionsupporting

confidence: 93%

“…It was reported that nonsmall-cell lung cancer with uncommon metastases such as the soft tissue, kidney, pancreas, spleen, peritoneum, intestine, bone marrow, eye, ovary, thyroid, heart, breast, tonsil, and nasal cavity tends to indicate a poor outcome [19]. However, the clinical incidence of lung cancer metastasis to gastrointestinal sites has been reported to be as low as 0.2%-1.7% [20][21][22]. Every type of lung cancer can result in gastrointestinal metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics and Prognosis of Gastrointestinal Metastases in Solid Tumor Patients: A Retrospective Study and Review of Literatures

Wang

Tang

et al. 2019

Analytical Cellular Pathology

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Background. According to the literature and our experience, patients with gastrointestinal metastases are relatively rare. Numerous case reports and literature reviews have been reported. We present one of the larger case series of gastrointestinal metastases. Objectives. To explore the clinical characteristics and prognosis of patients with gastrointestinal tract metastases, which are rare metastatic sites. Methods. Patients with gastrointestinal metastases in the setting of stage IV primary carcinomas treated at Beijing Ditan Hospital and Peking University International Hospital from November 1992 to August 2017 were included in this study. The diagnosis of gastrointestinal tract metastases was based on histopathology. Results. 30 patients (median age 56 years, 56.7% female) were included. The most common primary carcinomas associated with gastrointestinal metastases were breast (11 patients, 36.7%), stomach (9 patients, 30.0%), and lung (4 patients, 13.3%) cancer. The major pathological types were adenocarcinoma (16 patients, 53.3%) and ductal carcinoma (9 patients, 30.0%). Ten patients (33.3%) underwent local gastrointestinal treatment, and 20 patients (66.7%) underwent nonlocal treatment (involving chemotherapy alone or best supportive care). For breast cancer patients and gastric cancer patients who underwent local therapy, a significant survival advantage was observed (p=0.001 and p=0.012, respectively). The presence of other common metastases was identified as an independent poor prognostic factor through multivariate analysis with a HR (hazard ratio) of survival of 0.182 (95% confidence interval (CI) 0.11-0.523, p=0.031). Conclusion. Gastrointestinal metastases are most frequently from breast invasive ductal carcinoma. The presentation of other common metastases with gastrointestinal metastasis indicates poor prognosis, and selected patients may benefit from surgical intervention.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Gastrointestinal Metastases in Solid Tumor Patients: A Retrospective Study and Review of Literatures

Wang

Tang

et al. 2019

Analytical Cellular Pathology

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“…Only a few cases of metastatic lesion as the initial manifestation of lung cancer are described in literature (2,5), and none are with squamous cell carcinoma of the lung. The outcome of patients with GI metastases is very poor, and most of the patients succumb to their disease within 6 months after the diagnosis, as was the case with our patient (2,4,5).…”

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confidence: 61%

Metastatic small bowel occlusion as initial presentation of squamous cell carcinoma of the lung

Costa

Vieira

Costa

et al. 2019

Turk J Gastroenterol

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Dear Editor,We report the case of a 68-year-old man who presented at the emergency department with abdominal pain, vomiting, and constipation that progressively became worse over a 1-month period. His social history was notable for a remote phase of smoking. On physical examination, the patient was found to be hemodynamically stable, and his abdomen was tender with diffuse periumbilical pain on palpation. His laboratory results showed hemoglobin of 12.4 g/dL (normal, >13 g/dL), white blood count of 13000/ uL (normal, 4000-11000/uL), and C-reactive protein level of 96.4 mg/L (normal, <2.9 mg/L). Abdominal computerized tomography (CT) scan revealed focal thickening of the ileal segment ( Figure 1a). Additional thoracic CT revealed a left upper lobe mass (50×55 mm) ( Figure 1b). The patient underwent bronchofibroscopy and an exploratory laparoscopy with enterectomy. The cytology of the bronchial aspirate and histology of the ileal enterectomy were consistent with squamous cell carcinoma of the lung with intestinal metastasis, respectively (Figure 2a, 2b, respectively). The neoplasia was completely staged as squamous cell carcinoma of the lung, stage IV cT2b-N2M1b (mediastinal and left hilar lymph nodes and liver metastases) according to the 7th edition of TNM classification (1). The patient was treated with palliative chemotherapy with carboplatin and gemcitabine (6 cycles) and died 6 months after the diagnosis.Lung cancer is one of the most common cancers worldwide and is the leading cause of cancer-related deaths with a 5-year survival of 10%-25% (2). In non-small-cell lung cancers (NSCLC), approximately 40% of the patients have metastatic disease at the time of presen-tation (1). NSCLC can metastasize to nearly any organ, but it usually spreads to the brain, liver, adrenal glands, bone, and lung. Clinically significant small bowel metastases are rare (frequency of 0.5%) (2), and its diagnosis is usually based on post-mortem examination [12% of prevalence of gastrointestinal (GI) metastases and 8.1% in small bowel] (3). Small bowel, especially ileum, is the most commonly reported site for GI-tract metastasis of lung cancer. Small bowel metastases may occur in every cell type of primary lung cancer. The pathogenesis of small bowel metastases has been thought to be due to tumor cell spread via the hematogenous and lymphatic routes. Tumor invasion of the bowel wall results in perforation, obstruction, and bleeding. It appears that perforation or hemorrhage can also occur in patients under chemotherapy because chemotherapy may lead to tumor necrosis and acute ulceration (4). The difficulty in early detection of GI metastases leads to a delay in diagnosis until presenting with life-threatening complications that frequently require emergency surgeries (4). The time between the diagnosis of squamous cell carcinoma of the lung and the discovery of GI metastases is extremely variable, occurring more often in the first 12 months (2,4).In this case report, small bowel obstruction was the initial clinical symptom for this pat...

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“…Unusual metastatic sites, such as the small intestine and skin, have also been documented [ 2 , 3 ]. However, appendiceal metastasis from LC is rare; it was reported in 1 of 2066 patients with LC [ 4 ]. Unfortunately, appendiceal metastasis often results in acute appendicitis (AA) that requires emergent surgery.…”

Section: Introductionmentioning

confidence: 99%

Acute appendicitis caused by metastatic adenocarcinoma from the lung: a case report

et al. 2018

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BackgroundAppendiceal metastasis from lung cancer is rare. However, it often causes acute appendicitis that requires emergency surgery. We herein report a thought-provoking case of appendiceal metastasis from lung cancer.Case presentationA 71-year-old man was diagnosed with advanced lung cancer with multiple metastases and underwent chemotherapy. One month later, he developed acute appendicitis, and laparoscopic appendectomy was promptly performed. A swollen appendix and pus collection were observed during surgery. Histological analysis revealed an invasive adenocarcinoma in the appendix that infiltrated the mucosal, submucosal, and muscular layers. Positive immunostaining of thyroid transcription factor 1 indicated appendiceal metastasis of pulmonary adenocarcinoma, not a primary appendiceal malignancy. The postoperative course was uneventful, and the patient’s pulmonary internist resumed continuous chemotherapy after surgery.ConclusionsAlthough appendiceal metastasis from pulmonary adenocarcinoma is rare, it often results in acute appendicitis. Optimal therapy including emergency surgery should be performed without hesitation so that chemotherapy can be resumed as soon as possible.

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Analysis of gastrointestinal metastasis of primary lung cancer: Clinical characteristics and prognosis

Cited by 40 publications

References 27 publications

Clinical Characteristics and Prognosis of Gastrointestinal Metastases in Solid Tumor Patients: A Retrospective Study and Review of Literatures

Clinical Characteristics and Prognosis of Gastrointestinal Metastases in Solid Tumor Patients: A Retrospective Study and Review of Literatures

Metastatic small bowel occlusion as initial presentation of squamous cell carcinoma of the lung

Acute appendicitis caused by metastatic adenocarcinoma from the lung: a case report

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