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Case Reports
. 2010 Dec;128(6):371-4.
doi: 10.1590/s1516-31802010000600011.

Synchronous thyroid and colon metastases from epidermoid carcinoma of the lung: case report

Carla Rameri Alexandre Silva de Azevedo  1 , Loureno Cezana, Eduardo Sampaio Patrício de Moraes, Maria Dirley Ferreira de Souza Begnami, Tadeu Ferreira Paiva Júnior, Aldo Lourenço Abbade Dettino, Marcello Ferretti Fanelli
Affiliations
Case Reports

Synchronous thyroid and colon metastases from epidermoid carcinoma of the lung: case report

Carla Rameri Alexandre Silva de Azevedo et al. Sao Paulo Med J. 2010 Dec.

Abstract
in English, Portuguese

Context: Non-small cell lung cancer (NSCLC) progresses to distant metastases in most cases. The most frequent sites for distant metastases are the bones, central nervous system, adrenal glands and liver. Dissemination to the skin, myocardium, thyroid gland and intestine may occur, but is rare.

Case report: We describe a case of squamous cell carcinoma in the lungs, with metastases in the colon and thyroid, in a 66-year-old female patient. The lesion was unresectable and chemotherapy was started. The patient evolved with intestinal subocclusion, and colonoscopy showed the presence of a polyp. Biopsy and immunohistochemical analysis on the polyp showed that it was compatible with squamous cell carcinoma of pulmonary origin. At a follow-up consultation, the patient presented a thyroid nodule. A aspiration biopsy and cellblock immunohistochemistry confirmed the squamous cell carcinoma of pulmonary origin. After third-line chemotherapy, the patient progressed with acute obstructive abdomen due to a retroperitoneal mass. She underwent exploratory laparotomy and died due to surgical complications. Metastases to the thyroid and colon are rarely reported in cases of epidermoid carcinoma of the lungs. Gastrointestinal involvement in pulmonary metastases may affect the stomach, small intestine and colon, and cases of bleeding and perforation have already been reported. Although richly vascularized, the thyroid is an infrequent site for metastases. Such sites reflect poor prognoses for the clinical evolution. We did not find any previous reports in the literature, on lung cancer with metastases concomitantly in the colon and thyroid, in a single patient.

CONTEXTO:: O câncer de pulmão de células não pequenas evolui, na maioria dos casos, com metástases a distância. Ossos, sistema nervoso central, glândula adrenal e fígado são os sítios mais frequentes de metástases. Disseminação para pele, miocárdio, tireoide e intestino pode ocorrer, entretanto é rara.

RELATO DE CASO:: Descrevemos um caso de carcinoma espinocelular (CEC) de pulmão com metástase em cólon e tireoide, em mulher de 66 anos. A lesão era irressecável, e foi iniciada quimioterapia. A paciente evoluiu com suboclusão intestinal e a colonoscopia evidenciou pólipo colônico cuja biópsia e imunoistoquímica (IHQ) foram compatíveis com CEC de origem pulmonar. Em consulta de acompanhamento, detectou-se nódulo tireoidiano cuja punção aspirativa e IHQ de cellblock confirmaram CEC de origem pulmonar. Após quimioterapia de terceira linha, a paciente evoluiu com abdome agudo obstrutivo por massa retroperitoneal, sendo submetida a laparotomia exploradora, vindo a falecer por complicações da cirurgia. Metástases para tireoide e cólon são raramente reportadas em carcinomas epidermoides de pulmão. O envolvimento gastrointestinal por metástases de pulmão pode acometer estômago, intestino delgado e cólon, e casos de sangramento e perfuração já foram reportados. Embora ricamente vascularizada, a tireoide é sítio infrequente de metástases. Os sítios refletem prognósticos reservados na evolução clínica. Não encontramos, na literatura, relato prévio de câncer de pulmão com metástases em cólon e tireoide concomitantes em um único paciente.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1.
Figure 1.. Immunostaining (x 200). A – Staining positive for CK7 in neoplastic cells in colon. B (x 200) and C (x 400) – Staining positive for 34BE12 (B – colon; C – thyroid gland).
Figure 2.
Figure 2.. Computed tomography of thyroid mass.
Figure 3.
Figure 3.. Abdominal X-ray. A and B: small bowel distention.
See this image and copyright information in PMC

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