Dear Editor: Lung cancer is the most common cancer-related death in both men and women in the world. Approximately 25% of all cancer deaths are attributable to lung carcinoma. Moreover, about one-half of patients with lung cancer have metastases at the time of initial diagnosis, most frequently of lymph nodes, adrenals, liver, bone, and brain. However, metastasis to the colon is very rare. Over the past 25 years, about 13 cases of symptomatic colonic metastases from lung malignancies of all types have been reported in the literature. Hypercalcemia and leukocytosis are two of the most common paraneoplastic syndromes associated with various malignancies. However, concomitant manifestation of hypercalcemia and leukocytosis are occasionally observed in the same cancer patients. In this study, we present a rare case of colonic metastasis from a squamous cell carcinoma of the lung associated with paraneoplastic syndromes of hypercalcemia and leukocytosis. A 72-year-old man was referred to the hospital with a 10day history of abdominal pain. He complained of passing six stools per day with mucus but no obvious blood loss, and also a loss of almost 5 kg in weight. He had a right lower pneumonectomy 5 weeks ago because of squamous cell carcinoma of the lung. On physical examination, the patient was thin, and a tender right lower epigastric mass was found that measured 7×5 cm. Other clinical evaluation, including rectal examination, was unremarkable. Routine hematological profiles revealed that his white blood cell count was elevated. Laboratory data were as follows: 16.1×10/l, NE 0.671, HGB 141 g/l, TP 52.3 g/l, ALB 26 g/l, serum calcium 3.12 mmol/l (2.25∼2.75 mmol/l), CEA1.85 ng/ml (0∼3.4 ng/ml), and CA19-9 12.4 U/ml (0∼39 U/ml). A routine chest X-ray was reported as normal. Computed tomography (CT) confirmed a 7-cm mass in the right lower quadrant. He received 2 weeks of conservative treatment for a potential appendiceal abscess, but there was no change in the mass. In view of possible malignant colonic disease, the patient underwent an exploratory laparotomy, which showed the tumor at the cecum to be adherent to the abdominal wall and regional lymph nodes were also involved. A curative resection was not possible so a biopsy of the lesion was made. The pathological examination demonstrated that the colonic lesion was compatible with metastases from squamous cell carcinoma of the lung. He eventually died 4 weeks later due to respiratory failure, from a combination of disease progression and infection. Lung cancer is the most common cancer-related death in both men and women in the world. Around 50% of cases have demonstrable metastases at the time of presentation. The most common metastatic sites are lymph nodes, adrenals, liver, bone, and brain. Gastrointestinal metastases are not an unknown finding at post mortem. It was reported that solitary metastases occurred in only 3 of 423 cases. Colonic metastasis usually occurs late in the disease and is typically present after diagnosis of the primary tumor. Symptomatic colonic metastases have been reported previously but are rare. In the past 25 years, about 13 cases of symptomatic colonic metastases from lung malignancies of all types have been reported in the literature. Occasionally, the lung primary and colonic lesions present simultaneously. They are usually associated with widespread metastases. However, our case represents either a rare case of colonic Int J Colorectal Dis (2008) 23:129–130 DOI 10.1007/s00384-006-0256-9
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Jan 1, 2021
Keita Saito + 5
Open Access
