Metastatic Lung Cancer Diagnosed by Capsule Endoscopy

Abstract

Results: Case: 71 yo man with intermittent “black” colored stools for several months underwent capsule endoscopy after an unremarkable EGD and a colonoscopy evaluation. He denies any abdominal pain, nausea, hematochezia, and is unaware of any weight loss. Medical history includes diabetes and hyperlipidemia, which he is on the appropriate medications. There is no iron supplementation, but he is on a daily baby aspirin. His family history is negative for IBD and celiac disease. He has a 120 pack-year history of nicotine abuse, but quit 10 years ago. Laboratory evaluation was pertinent for microcytic anemia. Capsule endoscopic exam revealed an ulcer in the distal small bowel. Double balloon enteroscopy and surgery were discussed with the patient after the capsule endoscopy findings. Patient elected laparotomy, and a 9 cm × 4 cm × 2 cm segment of the small bowel was resected. Within the specimen was a 6 cm × 3 cm polypoid, fungating mass. Mass was consistent with high grade, poorly differentiated malignant neoplasm, favoring metastasis as there lacked mucosal dysplasia. Immunohistochemical staining of the neoplasm indicated the primary source to be the lung. CT of the chest revealed a 4 cm mass at the left upper lobe (LUL) with suspicious lymph nodes. Consequently, patient underwent a LUL lobectomy with node sampling, confirming the primary source. Discussion: Small bowel malignancies are rare and account for 0.4% of all cancers. In addition to melanoma, breast, lung, and renal cancers can metastasize to the small bowel by hematogenous spread. Cervical, ovarian, and colon cancers can involve the small bowel by direct extension. In this case, we describe the first case of metastatic lung cancer to the small bowel diagnosed by capsule endoscopy.Figure