A rare case of advanced lung cancer presenting as a symptomatic gastric tumor

Abstract

Although gastric metastases have been estimated to occur in less than 2% of cancer patients, an increased use of upper digestive tract endoscopy allows for a higher detection of secondary gastric tumors. We describe the case of a 66-year-old male patient presenting with mild pain in the sternum and upper abdominal area. Physical examination revealed a right parietal skull tumor, with no other significant clinical changes. Upon exclusion of an acute coronary syndrome, upper digestive tract endoscopy was performed, showing the presence of an ulcerated tumor located in the gastric fundus. Histopathologic examination of the biopsy sample and immunohistochemical tests suggested a pulmonary origin of the gastric tumor. Whole body computer tomography showed the presence of tumors in the gastric fundus, left lung, liver, kidneys, bones and brain. Transbronchial biopsy of the lung tumor certified the diagnosis of non-small cell lung cancer, with the same immunohistochemical profile as the gastric tumor. Hence, it was considered the origin of the metastases. Biopsy of the skull tumor also had the identical tumor histology. Whole brain radiotherapy was performed for the brain metastases and subsequent chemotherapy was administered. Although non-specific, gastrointestinal signs and symptoms occurring in lung cancer patients should alert the clinicians as to the possibility of gastrointestinal metastases and prompt endoscopic evaluation.

Keywords: gastric metastases; immunohistochemistry; non-small cell lung cancer.

Figure 1.

(A) Hematoxylin and eosin (×20) and immunohistochemical staining (×10) results of the gastric tumor biopsy showing poorly differentiated carcinoma. (B) Strongly positive CK34βE12 staining.

Figure 2.

(A) Hematoxylin and eosin (×10), and (B) immunohistochemical staining (×10) results of the transbronchial lung biopsy showing the invasion of squamous cell carcinoma and expression of P63.

Figure 3.

Hematoxylin and eosin (×10) and immunohistochemical staining (×10) results of the skull tumor biopsy showing carcinoma with morphology similar to that of the primary tumor in (A) the lung. (B) Strongly positive CK34βE12 staining.