Colonic metastasis from a primary adenocarcinoma of the lung presenting with acute abdominal pain

Abstract

A 62-year-old man presented with acute abdominal pain due o intestinal subobstruction. He had previously been treated by adiotherapy for pulmonary adenocarcinoma. The patient underent a colonoscopy revealing an ulcerated polypoid lesion, 3 cm n diameter, in the left flexure (Fig. 1). Histology revealed adeocarcinoma which, at immunohistochemistry, was positive for hyroid transcription factor-1 (TTF-1) [A] and cytokeratin 7 (CK-7) B], and negative for caudal-related homeobox transcription facor 2 (CDX-2) [C], sinaptofisin and cytokeratin 20 (CK-20) [D] (Fig. ). Accordingly, the lesion was interpreted as metastatic from the ung. The patient was referred to the Oncology Unit for additional hemotherapy. Although metastases to the gastrointestinal (GI) tract are found n as many as 11.9% of autopsies in patients with lung cancer, the eported clinical incidence of symptomatic GI metastases from this ype of tumour is very low (0.2–0.5%) [1]. However, the current opinion is that colonic metastases are nder-diagnosed in living patients because they have poor clinical anifestations and are frequently regarded as part of generalized etastatic disease are wrongly attributed to other lesions, such as lcers or colitis. This case suggests that a lesions of the colon in patients with lung ancer should be investigated by histology to exclude the possibility f a metastasis and to avoid dangerous endoscopic resection of a econdary lesion.