Recurrent jejunal metastasis from occult lung cancer

Abstract

Herein is reported the case of a 65 year-old woman with acute intestinal obstruction. A computed tomography (CT) revealed a solid stenosing mass of 5 × 5 cm located at proximal jejunum (Fig. 1). At surgery, a partial resection of the small bowel was done and a entero-entero anastomosis was performed. Histological diagnosis revealed a metastasis from lung adenocarcinoma (immunohistochemistry: CDX-2, CK7, and TTF-1 positive) (Fig. 1), thought chest CT and FDG-PET did not detect any macroscopic primary lung tumor. After two years, the patient developed a relapse of the disease at the same site (Fig. 2). At the time of recurrence, an accurate screening for pulmonary primary using CT, PET/CT and bronchoscopy was performed. No macroscopic lung disease was detected. We hypothesized that the recurrence in the same site was due to the existence of a well-defined pathway (hematogenous or lymphogenous paths) for the spread of the disease. Fig. 2Magnetic resonance imaging reveals a large relapse at the site of the previous jejunal anastomosis (yellow arrowheads). View Large Image Figure Viewer Download Hi-res image