Abstract
BackgroundRectal metastasis from pulmonary adenocarcinoma is rare, and it has been regarded as an end-stage phenomenon. Recently, however, advances in lung cancer treatment have improved the chance of long-term survival of patients with unresectable distant metastases. We describe the occurrence and management of metastatic spread of a pulmonary carcinoma to the rectum.Case presentationThe patient was a 79-year-old woman who had undergone thoracoscopic left lobectomy for pulmonary adenocarcinoma and then, over the next 11 years, various drugs (carboplatin + paclitaxel (as adjuvant therapy), gefitinib, gemcitabine + vinorelbine, S1 (an oral 5-fluorouracil-based drug), carboplatin + pemetrexed + bevacizumab, erlotinib, nivolumab, afatinib, and carboplatin+ S1) were administered, especially for hilar and mediastinal lymph node recurrences. During the eleventh postoperative year, left and right iliac bone metastases were detected, and radiation therapy was undertaken for local control of these lesions. When 18F-fluorodeoxyglucose positron emission tomography was performed for evaluation of the disease, tracer accumulation in the upper rectum was seen. Colonoscopic examination of the rectum revealed an intramural mass with central ulceration, and the mass was diagnosed histologically as an adenocarcinoma. The bone metastases appeared to be controlled, and the patient’s performance status was good, but she had suffered constipation for about a year and desired treatment. Thus, laparoscopic low anterior resection was performed. Histopathologic analysis revealed a moderately differentiated adenocarcinoma existing mainly between the submucosa and serosa, and immunohistochemical analysis showed the tumor to be positive for cytokeratin (CK) 7, negative for CK20, positive for thyroid transcription factor-1, and negative for special AT-rich sequence-binding protein 2 and caudal type homeobox 2, confirming the diagnosis of rectal metastasis from the primary pulmonary adenocarcinoma. The patient recovered well without any change in her functional status. Systemic chemotherapy was resumed, and she continues to do well, now 6 months after surgery.ConclusionsSurgery may be a good option for the management of an isolated rectal metastasis from pulmonary cancer in patients whose functional status is good.
Highlights
Rectal metastasis from pulmonary adenocarcinoma is rare, and it has been regarded as an end-stage phenomenon
Surgery may be a good option for the management of an isolated rectal metastasis from pulmonary cancer in patients whose functional status is good
The tumor cells were positive for cytokeratin (CK) 7 and thyroid transcription factor-1, and negative for CK20, special AT-rich sequence-binding protein 2, and caudal type homeobox 2 (Fig. 2d–h), together indicating that the tumor was a metastatic lesion originating from the lung adenocarcinoma [16,17,18,19]
Summary
Lung carcinoma is the leading cause of cancer-related death worldwide, and non-small cell lung cancer (NSCLC) accounts for the majority of cases. Metastatic lesions are found in more than half of patients at the time NSCLS is diagnosed, with the metastasis occurring most commonly in the lymph nodes, brain, liver, bone, or adrenal glands [1]. Chest computed tomography leading up to the initial diagnosis of primary pulmonary adenocarcinoma revealed a 2-cm nodule in the left lower lung lobe, as seen in the a lung window image and b mediastinal window image. Our patient was of advanced age, and extra-GI metastasis had occurred, but there was no rectal perforation and, notably, the extraGI metastasis was controlled. Surgical management turned out to be a good option for her Our experience in this case of metachronous rectal metastasis from pulmonary adenocarcinoma after 11 years of chemotherapy, immunotherapy, and radiotherapy for recurrent lesions suggests that surgical management is a reasonable option for patients whose disease is controlled
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