Small Intestinal Metastasis Research Articles

小腸転移をきたした肺多形癌の2例

症例1は59歳，男性．右肺癌に対し手術を施行され，術後4年目に腸重積による急性腹症をきたし，小腸腫瘍摘出術施行．病理学的には肺癌の小腸転移であった．術後4カ月目までは経過良好であったが，リンパ節転移等をきたし，術後7カ月で永眠された．症例2は45歳，男性．右肺癌に対し手術施行され，術後1年目に腹痛が出現．精査にて小腸腫瘍が疑われ，小腸摘出術施行．病理学的に肺癌の小腸転移であった．肺癌の小腸転移はまれで予後不良であるが，手術によりQOL改善が望める例も少なくなく，特に肺多形癌の腹部症状出現時には小腸転移も念頭に置いた精査および治療法選択を行うことが重要であると考えられた．

Sa1722 Capsule Endoscopy Versus Position Emission Tomography for Detection of Metastatic Small Intestinal Melanoma: A Tertiary Cancer Center Experience

Melanoma is one of the most common tumors to metastasize to gastrointestinal (GI) tract. Small intestine is the most common site of metastasis of GI tract. Position emission tomography (PET)-CT scan is the most sensitive and widely used tool to diagnosed visceral and non-visceral metastasis of melanoma. The aim of the study was to compare agreement between capsule endoscopy (CE) and PET-CT scan in detecting small intestinal metastasis in patients with metastatic melanoma.

Jejunal Intussusception Due to Malignant Phyllodes Tumor of the Breast

Phyllodes tumors are rare fibroepithelial neoplasms of the breast; classified as benign, borderline, or malignant based on the mitotic activity, cellular atypia, and stromal overgrowth. Wide surgical excision is the treatment of choice. The most common locations for metastasis are lung, bone, and liver; small intestinal metastasis is extremely rare. Here we present the first patient with jejunal metastases and intussusception due to malignant phyllodes tumor of the breast. Adjuvant treatment of malignant phyllodes tumor needs to be investigated.

腎摘出10年後に小腸転移を認めた腎細胞癌の1例

症例は82歳，男性．10年前に腎細胞癌（stageIII）に対して右腎摘出術を施行した．今回は小腸腫瘍によるイレウスから消化管穿孔を起こし，緊急手術となった．病理結果から小腸腫瘍は10年前の腎細胞癌の小腸転移であることが判明した．術後は一時的にICU管理を必要とするも，次第に改善し，術後32日目に転院となった．小腸転移を伴った腎細胞癌は，検索した範囲で本邦では40例が報告されている．血行性に転移するため肺転移を伴うことが多いが，本症例のように肺転移が無いものはまれである．腎細胞癌は異時性に転移を起こすことがあり，腎摘出後も長期間の経過観察が必要である．消化管転移例は，一般的に予後不良だが，生存期間の延長・QOL改善のために手術も考慮すべきである．

A Case of Lung Squamous Cell Carcinoma With Metastases to the Duodenum and Small Intestine

Gastrointestinal metastasis of lung cancer is fairly rare, and metastasis to the duodenum is very uncommon. We report a case of duodenum and small intestine metastases of lung squamous cell carcinoma. The patient was a 66-year-old man. He was diagnosed with lung squamous cell carcinoma (T4N3M1 [mediastinum, cervical lymph node, and duodenum metastases], stage IV). He noted a sense of abdominal fullness on the evening of the day chemoradiotherapy was given, and emergency surgery was performed for suspected perforation of the digestive tract. Intraoperative findings included a tumor in the small intestine with a perforation at the tumor site; partial resection of the small intestine, including the tumor, was performed. Small intestine metastasis of lung cancer was diagnosed following histopathologic examination. When lung cancer patients complain of abdominal symptoms, it is important to consider gastrointestinal metastases in diagnosis and treatment.

術前診断に難渋した肺癌小腸転移の１例

術前診断に難渋した肺癌小腸転移の１例

A Case of Intussusceptions Due to Small Intestinal Metastases after Resection of Right Upper Thigh Malignant Fibrous Histiocytoma

症例は55歳の女性で，右大腿軟部肉腫の診断にて根治術施行された．病理組織学的検査にてMalignant fibrous hisciocytoma（MFH）の確定診断となり，術後化学療法を施行されていた．1年11か月後，follow中のCTにて両側肺転移の診断となった．手術予定となるも下血・貧血が出現した．下部消化管内視鏡検査にて回盲部に腫瘍が指摘された．腫瘍部生検を行い，消化管精査後の待機手術を予定されたが直後より嘔吐などの腸閉塞症状を併発し当科紹介，緊急の開腹手術となった．術中所見では空腸と回腸に1か所ずつ計2か所の病変部を認め，空腸の再発巣は腸重積を呈していた．この2病変に対し小腸部分切除術を施行した．病理組織学的検査所見でMFHの再発と診断された．腹腔外を原発とする悪性腫瘍が腸管へ転移し手術加療を行う例は少なく，その中でも腸重積を呈する症例は非常にまれであり，文献的考察を加え報告する．

Intussusception of small intestine due to metastasis of large cell carcinoma of the lung with a rhabdoid phenotype

Large cell carcinoma of the lung with a rhabdoid phenotype is a rare type of lung cancer, and does not commonly metastasize to the small intestine. Herein we describe a 63-yr-old Japanese male with ileus resulting from small intestinal metastasis from lung cancer. Tumour enlargement was rapid and could not be treated with chemotherapy.

A case report and literature review of small intestinal metastasis of large cell lung cancer

A case report and literature review of small intestinal metastasis of large cell lung cancer

Ureteral cancer first recognized by mechanical ileus due to intestinal metastasis

We report a case of ureteral transitional cell carcinoma (TCC) first recognized because of mechanical ileus due to intestinal metastasis without definitive evidence of hydronephrosis or ureteral mass on plain computed tomography. We believe this to be the first case of ureteral TCC that was first recognized because of mechanical ileus due to small intestinal metastasis.

F-18 FDG PET-CT Imaging of Intestinal Metastasis From Primary Lung Cancer

Intestinal metastasis of lung cancer was diagnosed in a 67-year-old man with palpable masses in the axilla and lower abdomen. F-18 FDG PET/CT showed a large cavitary mass with an SUV of 14.1, which was similar to that of the lung mass, in the left lower quadrant of peritoneal cavity. Intestinal metastasis is rarely found, although symptoms related to the digestive tract are not uncommon in patients with lung cancer. Physicians should be aware of this possibility because a small intestinal metastasis often perforates, leading to life-threatening peritonitis.

Activation of CCR9/CCL25 in Cutaneous Melanoma Mediates Preferential Metastasis to the Small Intestine

Specific chemokines and their respective receptors have been implicated in distant tumor cell metastasis. Cutaneous melanoma has a distinct pattern of metastasis, preferentially targeting the submucosa of the small intestine. However, the underlying pathogenic mechanism remains unknown. Migration of CCR9(+) lymphocytes to the small intestine is known to occur in response to the chemoattractant effects of CCL25 (thymus-expressed chemokine). The integrin heterodimers alphabeta are also known to be important mediators of cellular adhesion. We hypothesize that the mechanism of small intestinal metastasis by melanoma is via the CCR9-CCL25 axis and specific integrins. Quantitative reverse transcription-PCR, flow cytometry, and immunohistochemistry were used to assess melanoma tumors for CCR9 and CCL25. Integrin expression was assessed using flow cytometry. CCR9 expression by quantitative reverse transcription-PCR was assessed in primary (n = 23) and metastatic (n = 198) melanomas, and melanoma lines derived from small intestinal metastases (n = 23). We showed CCR9 expression in 88 of 102 paraffin-embedded metastatic melanomas from the small intestine, 8 of 8 melanoma lines derived from metastases in the small intestine, and 0 of 96 metastatic melanomas from other sites. In vitro migration and invasion studies done on CCR9(+) melanoma lines showed migration in response to CCL25 that was inhibited by anti-CCR9 antibody or by short interfering RNA CCR9. Flow cytometric analysis confirmed CCR9 expression by melanomas to the small intestine and showed concomitant alpha(4)beta(1) integrin expression. Our findings show that functionally active CCR9 on melanoma cells facilitates metastasis to the small intestine. The CCR9-CCL25 axis may explain the high incidence of melanoma metastasis to this specific location.

A Case of Multiple Intussusceptions in the Small Intestine Caused by Metastatic Renal Cell Carcinoma

Renal cell carcinoma (RCC) may metastasize to almost any organ, but metastasis to the small bowel is rare. Small bowel metastasis from RCC can induce obstruction or bleeding, and perforation can also be induced in rare case. Yet RCC metastasis to the small bowel is unlikely to be a direct cause of intussusceptions. A few cases of intussusceptions caused by small intestinal metastasis of RCC have been reported, but multiple small intestinal intussusceptions are extremely rare. We report here on a 47-year-old male patient who presented to the emergency room with acute abdominal pain. He had undergone radical nephrectomy 2 years previously due to left RCC. The abdominal CT scan revealed enhanced masses with the "target" sign that suggested enteric intussusceptions in the jejunum. Eight pedunculated masses within the small intestinal lumen led to intussusceptions at 30 and 150 cm distal to Treitz ligament. Three segmental resections of the small intestine and functional end to end anastomosis were done. The patient recovered uneventfully from this operation. To the best of our knowledge, this is the 1(st) report of metastases from RCC that presented as synchronous intraluminal polypoid tumors, and these tumors served as the lead points for two intussusceptions in the jejunum.

Small bowel occlusion due to intussusception of a single metastasis of lung cancer

The occurrence of small bowel intussusception due to metastatic lung cancer is very infrequent. We present a case of young man recently diagnosed of non small cell lung cancer that had a unique small intestine metastasis. We discuss the diagnostic and therapeutic issues.

腹部超音波検査および腹部CTで術前診断しえた肺癌小腸転移穿孔の1例

腹部超音波検査および腹部CTで術前診断しえた肺癌小腸転移穿孔の1例

Functional CCR9 Expression Is Associated with Small Intestinal Metastasis

In general, metastases to the small intestine are rare, and mostly occur in melanoma. CCR9 has been shown to be the principal chemokine receptor for the thymus expressed chemokine (TECK), a chemokine selectively expressed in the small intestine and thymus. Here we show that CCR9 is highly expressed on melanoma cells and all melanoma cell lines isolated from small intestinal metastases, and on a proportion of cell lines from other sites. Only melanoma cells and cell lines from small intestinal metastases, however, were responsive to the CCR9 ligand TECK, as assessed by receptor downregulation and by actin polymerization. CCR9 expression was also found on the adenocarcinoma cell line CaCo-2 expressing characteristics of enterocytic differentiation, but not on any other cell line isolated from colorectal, breast, and lung cancer. Our data provide evidence that the aberrant functional cell surface expression of an organ-specific chemokine receptor is associated with metastasis to this site. The regulation of receptor function seems to be a critical step in the metastatic process.

Small intestinal metastasis from non–small-cell carcinoma of the lung: A rare cause of GI bleeding of obscure origin

Metastasis of primary carcinoma of the lung to the small bowel is rare. It seldom becomes clinically manifest, but symptoms include GI perforation, obstruction, and/or hemorrhage.1 To our knowledge, only 14 cases of GI hemorrhage secondary to small bowel metastasis of a primary carcinoma of the lung have been reported.1–13 A case is reported of a 73-year-old woman with a history of non-small-cell lung carcinoma who presented with microcytic anemia because of GI bleeding of obscure origin. The small intestinal bleeding site was localized by labeled erythrocyte scintigraphy and subsequent push enteroscopy. Surgical resection was successful, and histopathologic examination of the specimen was consistent with a metastasis from the primary carcinoma of the lung. Reports of small bowel metastases of primary lung carcinoma are reviewed.

肺癌切除直後に胃・小腸転移が発見された１例

症例は46歳男性, 右肺癌の診断で, 肺全摘除およびリンパ節郭清を行った.組織学的に低分化腺癌と診断されたが, 大細胞癌も混在していた.術後, 心窩部痛を訴え胃内視鏡検査を行い, 胃体下部大弩に頂部がやや陥凹した隆起性病変を認めた.内視鏡的粘膜切除で低分化な癌細胞が証明され, 肺癌術後2ヵ月目に胃転移の疑いで開腹した.術中, 空腸にも腫瘤を認め幽門側胃切除術と小腸部分切除術を行った.組織学的に, 主に粘膜下層以深に大細胞癌を認め, 肺癌の胃および小腸転移と診断された.胃切後2ヵ月で脳転移が明らかになり, その後, 骨および肝転移も出現, 肺癌術後8ヵ月で死亡した.消化管転移をともなう肺癌はまれであるが, 予後不良であり, 慎重に治療方針の決定を行うことが重要と思われた.

A CASE REPORT OF INTESTINAL METASTASIS FROM MAXILLA CANCER

Small intestinal metastasis is very rare. We encountered a case of intestinal metastasis from maxilla cancer causing preoperative peritonitis. A 63-year-old man had under gone surgery for maxilla cancer in December of 1997 at another hospital. He was admitted to our hospital because of nausea, vomiting, and abdominal pain in March of 1999. Peritonitis was obvious and a CT scan revealed free air, so an emergency operation was performed. During surgery, about 1000ml of dirty ascites containing pus was noted in the abdominal cavity, and ring stenosis of the ileum was noted in the ileum about 20cm to the oral side from the ileocecal region. Perforation was found in the ring stenosis, and an ileocecal resection was performed. Histopathological studies of the tumor revealed poorly differentiated squamous-cell carcinoma, the same pathological type as the maxilla cancer which had been operated on before. The postoperative course was uneventful, but a CT scan of the chest revealed lung metastasis. As to the metastatic course of maxilla cancer, we consider that maxilla cancer metastasizes to the small intestine through the chest mediastinum by lymphatic flow or blood flow. We suggest that in this case metastasis by blood flow because lung metastasis had occurred previously.

Small intestinal metastasis from esophageal carcinoma associated with small intestinal obstruction: Report of a case

The small intestine is rarely involved with metastatic tumors from outside the abdomen, and few case reports have been documented in the literature. We describe herein what to our knowledge is the third case of a solitary metastasis from squamous cell carcinoma (SCC) of the esophagus being found in the jejunum, causing small intestinal obstruction.