Bardac Ovidiu D, Baciu Adina-Brînduşa, Bogdan-Duică Iancu S
Chirurgia (Bucur). 2020 Sept-Oct;115(5):681-689. doi: 10.21614/chirurgia.115.5.681.
Lung cancer is the most frequent cancer, accounting for over 2 million new cases per year worldwide. In Romania, the cancers with the highest incidence are lung cancer for men and breast cancer for women. Cancer-related deaths follow the same pattern. More than 50% of the patients with lung cancers have distant metastases at the time of diagnosis. Metastases from lung cancer occur mainly in the brain, bones, liver, and adrenals. Anal metastases from primary lung cancer are extremely uncommon. As far as we know there are only 12 cases reported in the literature until now. Case report: Case report and systematic review. We performed a systematic literature search in PubMed using the following MeSH terms: "lung cancer metastasis" AND "anal" OR "anus" OR "perianal". The search was conducted from the beginning of the database onwards. No language exclusion criteria were used. We report the case of a patient with advanced lung adenocarcinoma presenting with a painful, ulcerated and bleeding anal tumor. The anal tumor was excised with primary wound closure in spinal anesthesia. The pathology report and the immunohistochemistry of the specimen revealed metastasis of the lung adenocarcinoma. The review included 12 papers reporting 12 cases. The male/female ratio was 3/1. The average age was 62,16 years. Among these 12 patients, one had a SCLC. From the remaining 11 cases with NSCLC, 4 were adenocarcinomas, 4 squamous cell carcinomas, two anaplastic carcinomas and one mucoepidermoid carcinoma. The anal metastases were synchronous in 4 cases and metachronous in the rest of 8 cases. Since 2006 immuno-histochemistry plays an important role in the diagnosis of these metastases. Our patient presented an anal metastasis of a lung adenocarcinoma that was masquerading as a complicated hemorrhoidal disease. Because anal masses can be easily misdiagnosed, patients with lung cancers and anal or perianal complaints should be evaluated for metastatic disease. Medical teams that are managing such cases must be aware of this rare but possible situation. Immunohistochemistry plays an important role in establishing the diagnosis for the anal or perianal tumours in patients with lung cancer.
肺癌是最常见的癌症，全球每年新增病例超过200万例。在罗马尼亚，男性发病率最高的癌症是肺癌，女性是乳腺癌。癌症相关死亡情况也遵循相同模式。超过50%的肺癌患者在诊断时已有远处转移。肺癌转移主要发生在脑、骨、肝和肾上腺。原发性肺癌的肛门转移极为罕见。据我们所知，迄今为止文献中仅报道了12例。病例报告：病例报告及系统综述。我们在PubMed中使用以下医学主题词进行了系统的文献检索：“肺癌转移”以及“肛门”或“肛管”或“肛周”。检索从数据库建立之初开始。未使用语言排除标准。我们报告一例晚期肺腺癌患者，其出现疼痛、溃疡且出血的肛门肿物。在脊髓麻醉下切除肛门肿物并一期缝合伤口。标本的病理报告及免疫组化显示为肺腺癌转移。该综述纳入了12篇报告12例病例的论文。男女比例为3∶1。平均年龄为62.16岁。在这12例患者中，1例为小细胞肺癌。其余11例非小细胞肺癌中，4例为腺癌，4例为鳞状细胞癌，2例为间变性癌，1例为黏液表皮样癌。4例肛门转移为同时性，其余8例为异时性。自2006年以来，免疫组化在这些转移瘤的诊断中发挥着重要作用。我们的患者表现为肺腺癌的肛门转移，最初被误诊为复杂性痔病。由于肛门肿物容易误诊，对于有肺癌且伴有肛门或肛周不适的患者，应评估是否存在转移瘤。处理此类病例的医疗团队必须意识到这种罕见但可能出现的情况。免疫组化在肺癌患者肛门或肛周肿瘤的诊断中起着重要作用。
