Small intestine metastasis from lung adenocarcinoma: A case report and review of literature

Abstract

Background: The clinical metastasis rate of lung cancer is tremendously low in gastrointestinal tract. Individuals enduring small intestine metastasis of lung cancer are normally featured by less desirable prognosis and shorter survival than those with metastasis in other parts of the body. As a consequence, it holds crucial significance to conduct early diagnosis and development of systematic treatment for patients with gastrointestinal metastasis in lung cancer.

Case summary: In this case, a 59-year-old female patient, diagnosed with lung adenocarcinoma, experienced intestinal obstruction attributable to subsequent small intestinal metastasis. Imaging confirmed the metastasis to the small intestine after the adenocarcinoma diagnosis, ultimately giving rise to advanced-stage intestinal obstruction. Conservative treatment proved ineffective, progressing to intestinal perforation in the later stages. This resulted in peritonitis and infectious toxic shock and other serious clinical manifestations. Aggressive surgical resection mitigated the risk of disease progression and even fatality, which tremendously ameliorated the patient's prognosis and prolonged her survival.

Conclusion: Patients enduring lung cancer who exhibit acute abdominal symptoms should be mindful of the potential for small intestinal metastasis. Intestinal perforation typically occurs in advanced stages of the disease. Moreover, and aggressive surgical treatment can mitigate the risk of multifarious complications such as peritonitis, infectious toxic shock, and even fatality.

Keywords: Case report; Diagnosis; Lung cancer; Metastasis; Small intestine; Treatment.

Figure 1

Abdominal upright plain film. Gas accumulation in the abdominal intestine, and scattered fluid levels are seen, indicating intestinal obstruction.

Figure 2

Representative whole-abdominal computed tomography images. Dilated intestinal collaterals are seen and adhesions of the small intestine to the abdominal wall are seen.

Figure 3

Small intestinal metastasis. A-D: First small intestine resection specimen. A: Hematoxylin-eosin × 40; B: Hematoxylin-eosin × 100; C: Hematoxylin-eosin × 200; D: Hematoxylin-eosin × 400; E-H: Second small intestine resection specimen (E: Hematoxylin-eosin × 40; F: Hematoxylin-eosin × 100; G: Hematoxylin-eosin × 200; H: Hematoxylin-eosin × 400).

Figure 4

Immunohistochemical tests (first small intestine resection specimen). A: Cytokeratin (CK) 7 (+++); B: Thyroid transcription factor-1 (++); C: Napsin A (+); D: CK20 (-); E: CDX2 (-).

Figure 5

Immunohistochemical tests (second small intestine resection specimen). A: Thyroid transcription factor-1 (+); B: Napsin-A (partially +); C: Cytokeratin (CK) 7 (+); D: CK20 (partially +); E: CDX2 (-); F: CK-pan (+); G: Vimentin (partially +).