Non-small Cell Lung Cancer With Neuroendocrine Features Presenting With Duodenal Mass and Lip Lesion

Abstract

A 76 year-old male with a past medical history significant for a 60 pack-year smoking history and COPD presented to our institution with symptoms of cough, shortness of breath, right-sided chest discomfort, and swelling of his left upper lip for the past two weeks. He denied fever or chills. Chest x-ray revealed a large right upper lobe mass, and computed tomography (CT) scan subsequently showed a right upper lobe mass measuring 8.1 x 8 x 8.4 cm (Figure 1) that was invading the right upper lobe bronchus and right main stem bronchus. He underwent bronchoscopy with transbronchial needle aspiration along with electrocautery debulking and argon laser ablation. He also underwent biopsy of the upper lip lesion. An abdominal CT scan performed for tumor staging showed a focally dilated segment of jejunum with surrounding fat stranding and lymphadenopathy including a 1.6 x 1.6 cm node with central hypoattenuation. A small bowel enteroscopy showed a large mass in the second portion of the duodenum that totally occluded the lumen and was not traversable (Figure 2). The biopsy pathology of the lesions from all three sites were positive for synaptophysin, CD56 and cytokeratin AE1/AE3, but negative for chromogranin. This is consistent with metastatic non-small cell lung cancer with neuroendocrine features. The patient elected not to have treatment for his cancer.Figure 1Figure 2Neuroendocrine tumors account for approximately 20% of lung cancers with the majority of those being non-small cell lung cancers.1 Gastrointestinal (GI) metastasis from primary lung cancer are uncommon, with a prevalence of 0.2 - 1.8%, but have occurred in 4.6%-11.9% of autopsy samples.2 Most cases of GI metastasis are asymptomatic, and diagnosis is made at time of recurrence.3 Here, we describe a rare case of neuroendocrine non-small cell lung cancer with simultaneous metastasis to the small intestine and oral cavity at the time of diagnosis.