Non-small cell lung cancer with gastric metastasis and repeated gastrointestinal bleeding: A rare case report and literature review

Abstract

The occurrence of gastrointestinal metastasis from lung carcinoma is rare. Compared with non-small cell lung cancer (NSCLC), small cell lung cancer more commonly results in this sort of metastasis. Here, we report an unusual case of NSCLC initially without evidence of distant metastasis that developed into gastric metastasis five months after the initial diagnosis, despite the primary lung cancer having a partial response to radiotherapy and chemotherapy. Serial radiological examinations and endoscopic biopsies of the gastric tumor confirmed that it was a metastatic carcinoma originating from the lung. The patient received a total gastrectomy for gastric metastasis due to repeated gastrointestinal bleeding.

Keywords: Gastrointestinal bleeding; metastasis; non-small cell lung cancer; stomach.

Figure 1

(a) The CT scan shows right upper lung non‐small cell lung carcinoma (NSCLC) (T3N0M0). The initial tumor size was 6.5 cm. (b) Five months after initial diagnosis, computed tomography (CT) demonstrated partial response (PR) to CCRT, and the tumor had decreased in size to 3.5 cm in diameter.

Figure 2

(a) Five months after the initial diagnosis of lung cancer, the computed tomography (CT) scan that revealed the partial response (PR) of the primary lung cancer also revealed a gastric tumor 4.2 cm in size. (b) Upper gastrointestinal endoscopy showed a massive (more than 5 cm), bleeding ulcerative mass in the anterior wall of the gastric high body. (c) Seven months after diagnosis, the CT scan revealed a bulky gastric mass at the greater curvature side of the high body 10.9 cm in size with left gastric and splenic hilar lymphadenopathy.

Figure 3

(a) The poorly differentiated tumor cells infiltrated underneath the mucosa and caused breaking of the surface. (b) The tumor lacked MUC5AC immunoreactivity, whereas normal gastric glands showed strong MUC5AC expression.