Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
Lung Cancer. 2011 May;72(2):255-7. doi: 10.1016/j.lungcan.2011.02.005. Epub 2011 Mar 10.
Metastasis from lung cancer, often found in the adrenal glands, bone, liver, brain, and kidneys, have been thought to be rare in the digestive system. When a metastatic tumor is found in the intestine, it is most commonly metastatic melanoma or carcinoma of the cervix uteri, ovary, or breast. Yet, intestinal metastases have been described in 11% of lung cancers at autopsy. These metastases may induce gastrointestinal perforation, obstruction, or bleeding. Patients with bleeding from small intestinal metastases secondary to lung cancer almost uniformly have poor prognoses. The lung cancer metastasized to the gastrointestinal site or location where a first primary cancer was once resected is never reported in the literature. We report the case of a 76-year-old man with a history of gastric adenocarcinoma treated by subtotal gastrectomy seventeen years ago who presented with lung cancer metastatic to the bone. One month later, he developed persistent melena due to duodenal metastases. Upper gastrointestinal endoscopy showed an ulcerative duodenal mass with bleeding. The pathohistological and immunohistochemical examinations of tissue from the pathologic fracture and the endoscopic biopsy specimen revealed metastatic poorly differentiated adenocarcinoma consistent with lung origin. The diagnosis of metastatic lung cancer can be rendered based on pathologic examination and immunohistochemical analysis, even without access to the primary lung tumor. In this case, the anastomosis site where a gastrectomy for gastric cancer was once performed might be a good niche or microenvironment for cancer cells or tumor stem cells to metastasize to.
肺癌转移，通常在肾上腺、骨骼、肝脏、大脑和肾脏中发现，在消化系统中被认为很少见。当在肠道中发现转移性肿瘤时，最常见的是转移性黑色素瘤或宫颈癌、卵巢癌或乳腺癌。然而，在 11%的肺癌尸检中已经描述了肠道转移。这些转移可能导致胃肠道穿孔、梗阻或出血。由于肺癌转移导致的小肠转移引起出血的患者预后几乎普遍较差。肺癌转移到胃肠道部位或曾经切除过原发癌症的部位在文献中从未报道过。我们报告了一例 76 岁男性的病例，他曾患有胃腺癌，17 年前接受了胃大部切除术，目前患有骨转移的肺癌。一个月后，他因十二指肠转移而出现持续黑便。上消化道内镜检查显示十二指肠有溃疡性肿块并伴有出血。病理性骨折和内镜活检组织的病理和免疫组织化学检查显示转移性低分化腺癌，与肺来源一致。即使无法获得原发性肺癌，通过病理检查和免疫组织化学分析也可以做出转移性肺癌的诊断。在这种情况下，曾经进行过胃癌胃大部切除术的吻合部位可能是癌细胞或肿瘤干细胞转移的良好小生境或微环境。
