Small Intestinal Metastasis From Carcinoma of the Lung
Authors: Noritoshi Kobayashi, Seitaro Watanabe, Kensuke Kubota
Journal: Clinical Gastroenterology and Hepatology (2011)

A 65-year-old man was admitted to our hospital with tarry stools. Endoscopic findings revealed a huge reddish mass with bleeding at the second portion of the duodenum (Figure A). Computed tomography revealed a small mass with a cavity in the left upper lobe of the lung (Figure B). The patient had aggressive anemia, and repeated blood transfusions were performed. We finally performed a palliative resection of the duodenal tumor. Intraoperative findings revealed multiple small intestinal tumors, and we performed a tumor resection with a duodenal wedge resection and an additional partial jejunectomy. The pathologic findings of the intestinal tumors revealed giant cells and spindle cells, so the tumors were diagnosed as anaplastic carcinomas. Transbronchial lung biopsy for the small lung mass was performed, followed by surgical resection. The pathologic findings of the lung also revealed giant cells and spindle cells, so the tumor was diagnosed as a pleomorphic carcinoma of the lung (Figure C). An immunohistochemical study for thyroid transcription factor-1 showed positive findings for both the lung and intestinal tumors (Figure D). We finally diagnosed the patient as having a pleomorphic carcinoma of the lung with multiple intestinal metastases. This patient was still alive at 3 months after the surgical resection. On the basis of the findings of 1775 patient autopsies, Uehara et al1Uehara K. Iijima K. Hasegawa S. et al.The metastasis to the digestive system from the primary lung cancer: a review of 1775 autopsies.Geka. 1979; 41 (in Japanese with English abstract): 1364-1367Google Scholar reported that metastasis to the digestive system from primary lung cancer occurs at a rate of 5.2% in the esophagus, 4.2% in the stomach, 4.5% in the small intestine, and 5.2% in the colon. A more recent study of patients with non–small cell carcinoma of the lung revealed small bowel metastases in 4.6% of the cases.2Ise N. Kotanagi H. Morii M. et al.Small bowel perforation caused by metastasis from an extra-abdominal malignancy: report of three cases.Surg Today. 2001; 31: 358-362Crossref PubMed Scopus (34) Google Scholar Small intestinal metastases have been reported to occur more frequently in the jejunum and terminal ileum than in the duodenum.3Berger A. Cellier C. Daniel C. et al.Small bowel metastases from primary carcinoma of the lung: clinical findings and outcome.Am J Gastroenterol. 1999; 94: 1884-1887Crossref PubMed Scopus (164) Google Scholar The main symptoms of small intestinal metastasis of lung cancer were gastrointestinal perforation and obstruction. The review by Jansen et al4Jansen J.M. Oldenburg B. van Milligen de Wit A.W. Small intestinal metastasis from non-small-cell carcinoma of the lung: a rare cause of GI bleeding of obscure origin.Gastrointest Endosc. 2004; 59: 447-449Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar revealed that a total of only 16 patients with gastrointestinal bleeding caused by small bowel metastasis of a primary carcinoma of the lung have been reported. Large cell carcinoma is the most common cell type, although pleomorphic carcinoma has also been reported.4Jansen J.M. Oldenburg B. van Milligen de Wit A.W. Small intestinal metastasis from non-small-cell carcinoma of the lung: a rare cause of GI bleeding of obscure origin.Gastrointest Endosc. 2004; 59: 447-449Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The prognosis for patients with small intestinal metastases of primary lung cancer generally is very poor, with reported survival after diagnosis ranging from weeks to a few months.