Gastric and Breast Metastasis From Lung Adenocarcinoma: A Case Report

Abstract

Introduction: Lung cancer is one of the most commonly diagnosed cancer and the leading cause of cancer mortality worldwide. Lung adenocarcinoma constitutes nearly 40 % of primary lung cancers. Its main metastatic sites are the liver, brain, adrenal glands, and bone. Metastasis to the gastrointestinal tract is infrequent, particularly to the stomach. Most cases of gastric metastasis are asymptomatic and are usually present in the submucosa. Case report:A 53 year-old female presented to the Emergency Department with severe epigastric pain of 4-day duration. The patient underwent a CT of the chest, abdomen and pelvis which showed a lobulated speculated 3 cm mass at the upper lobe of the left lung, a 3.3 cm mass in the tail of the pancreas, a 3.1 cm mass medially in the left breast, and extensive deposits in the superior mediastinum, at the right axilla, in the left upper lobe, precaval lymphadenopathy and multiple subcutaneous nodules highly suspicious for metastasis. To further evaluate the epigastric pain, the patient underwent an EGD which showed a 1.5 cm protruding subepithelial lesion with a central ulcer. The nodule was biopsied at the edges of the ulcer. Histological examination showed tumor cells consistent with adenocarcinoma. The tumor cells showed immunoreactivity with CK7, Thyroid transcription factor 1 (TTF-1) and Napsin A. They were negative for CK 20. The immunohistochemistry profile was most compatible with a primary lung neoplasm. A tissue biopsy was also obtained from the breast mass with similar immunohistochemical staining pattern further supporting lung as the primary site. A bone scan showed osseous metastasis. Conclusion: We report a rare presentation of lung adenocarcinoma with metastasis to both stomach and breast among other sites. Another unique finding is the symptomatology of the gastric metastasis as it presented with acute epigastric pain most likely due to the ulceration overlying the subepithelial metastatic gastric nodule. Gastrointestinal manifestations in cancer patients is usually attributed to chemotherapy but it could be due to gastrointestinal metastais as well.Figure 1Figure 2Figure 3