Upper Gastrointestinal Tract Metastasis from Lung Cancer

Abstract

Purpose: Hematogenous metastatic involvement of the stomach is rare. The most common primary tumors are malignant melanoma, breast carcinoma, and lung carcinoma. GI bleeding from lung carcinoma metastasis is very rare. A 62 year-old female with history of smoking and alcoholism presented with abdominal pain, melena, cough and 30-pound weight loss over a period of one month. She was hypotensive and tachycardic. Her hemoglobin was 9 g/dl. EGD showed multiple odd-looking lesions in the mid-gastric body measuring 1.5 cm with heaped up edges and central ulceration. Similar lesions were noted in the duodenal bulb, D2 and D3. One of the lesions in proximal D2 had a large central ulceration and a prominent vessel in the base. This was treated with injection of diluted epinephrine and gold probe cautery. Biopsy of the gastric lesion showed poorly differentiated large cell carcinoma. No Helicobacter pylori was detected. CT/PET scan showed avid uptake throughout the body, including the left hilum, adrenal glands and numerous osseous and soft tissue lesions. Given the overall poor condition and prognosis, the patient elected to be under hospice care. Gastrointestinal metastasis from lung cancer is uncommon. Gastric metastases usually are not detected during the life time of the patient. Hematogenous metastases are generally situated in the submucosa and often remain asymptomatic unless the mucosa becomes involved. The characteristic “volcano-like” appearance is a clue to the diagnosis.