Squamous cell lung carcinoma with gastrointestinal metastasis: a case report and review of literature

Abstract

Squamous cell lung carcinoma (LUSC) originates from squamous cells and has a high rate of metastasis and recurrence. The lack of effective genetic targets and specific therapies has resulted in a poor prognosis for patients with LUSC. Gastrointestinal metastasis of LUSC is a rare occurrence in clinical practice. Patients with gastrointestinal metastasis usually have worse overall survival and the process of diagnosis is more complicated than those with metastasis elsewhere. What's more, there are no helpful guidelines for treating patients with a clinically confirmed diagnosis of gastrointestinal metastasis, which means the treatment method is limited. Here, we review the clinical features, diagnosis, and treatment of LUSC patients with gastrointestinal metastasis and report a rare case of LUSC accompanied by gastrointestinal metastasis. The patient was admitted to the hospital with coughing and hemoptysis. A tumor was found in his lung, and lesions were initially controlled with standard treatment. The patient's tumor re-occurred again shortly for which treatment was lacking. Without effective treatment methods, the disease was difficult to control. Our learnings from the case demonstrate that LUSC metastasizes to secondary lymphoid organs of the gastrointestinal tract, usually with a poor prognosis.

Keywords: gastrointestinal metastasis; neoadjuvant chemoradiotherapy; rare cecum metastasis; squamous cell lung carcinoma (LUSC); surgical resection.

Figure 1

Immunohistochemical staining of histopathology: (A) Hematoxylin eosin staining of primary squamous cell carcinoma; (B) Immunohistochemical staining of P63; (C) Immunohistochemical staining of CK5/6; (D) Immunohistochemical staining of Ki67. Bar=100 um.

Figure 2

Systemic treatment strategies: (A) Whole-body PET-CT: maximum standardized uptake value: lung tumor 10.6, cecum 11.2, lumbar vertebra 15.7, inguinal groin 10.7, left ventricle 9.0, Cranial top skin 18.6; (B) Baseline computed tomography-enhanced CT of the chest; (C) The patient’s chest enhancement MRI was reassessed two weeks after chemotherapy; (D) MRI of lumbar spine metastases; (E) Review of chest, abdomen and pelvic enhancement CT; (F) MRI of the head suggests nasal and scalp neoplasm.

Figure 3

Radiotherapy plan: (A) Radiotherapy plan for the lumbar spine: Gross tumor volume (GTV L4-5) 35Gy/10F, Clinical target volume (CTV) 30Gy/10F; (B, C) Radiotherapy plan for inguinal metastatic lymph nodes: Gross tumor volume (GTVp) 52Gy/23F; (D-G) Radiotherapy plan for primary lung lesions: Gross tumor volume (GTVp) 47.6Gy/19F, Lymph node target volume (GTVn) 41.8Gy/19F.