Lung Cancer (2007) 55, 251—252

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LETTER TO THE EDITOR

Gastrointestinal solitary metastases from squamous cell lung cancer

KEYWORDSLung cancer;Metastases;Pancreas;

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Metastatic disease is a frequent clinical scenario in patientswith squamous cell lung carcinoma (LC). The most commoninvolved sites are bone, liver, adrenal gland and brain. Gas-trointestinal metastases have rarely been described. In mostcases they are found after primary lesion diagnosis, but canoccur synchronously or before the diagnosis of the primarytumor [1]. The usual presentation is multiple metastaticdeposits, but can also present as solitary lesions. Here, wepresent two unusual cases of gastrointestinal solitary metas-tases from squamous cell LC.

In the first case a 69-year-old female was diagnosedwith a mass in the right upper pulmonary lobe in Octo-ber of 2005. Histological examination showed squamouscell lung carcinoma of intermediate to low differentia-tion. Imaging studies did not reveal any other sites of dis-ease, but the patient was unable to proceed to a surgicalprocedure due to co-morbidities. Local radiotherapy fol-lowed and the patient remained in good condition untilMay 2006. At that time, the patient was admitted to ourHospital because of lower gastrointestinal bleeding, ane-mia, low-grade fever and hypercalcemia. Upper endoscopyrevealed no pathology. Colonoscopy followed which showedtwo lesions, the first at 15 cm and the second at 50 cm fromthe anal canal causing significant narrowing of the lumen(Fig. 1A). Biopsies revealed metastatic deposits from theinitial squamous cell lung carcinoma. Physical examination,hematological and radiological work-up did not reveal anyother site of disease. The patient underwent an emergencyoperation.

In the second case a 56-year-old male was diagnosed

with a mass in the left upper pulmonary lobe in Decem-ber of 2002. He underwent a left pneumonectomy andhistological examination showed a well-differentiatedsquamous cell lung carcinoma. Adjuvant chemotherapywith four cycles of paclitaxel/cisplatin was administered.

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0169-5002/$ — see front matter © 2006 Elsevier Ireland Ltd. All rights redoi:10.1016/j.lungcan.2006.10.009

he patient remained disease free until April 2006. At thatime, he was admitted to our Hospital due to abdominalain, nausea, weight loss and jaundice over the previ-us week. In physical examination he was jaundiced,hile all other systems were normal. Laboratory tests

howed conjugated bilirubinemia along with abnormaliver biochemistry. Abdominal unltrasound demonstrated

hypoechogenic lesion in the head of the pancreas andntrahepatic biliary duct dilatation. Abdominal computedomography revealed a solid mass in the head of theancreas and a fine needle biopsy followed (Fig. 1B).istopathologic examination revealed metastatic infiltra-ion from the initial squamous cell lung carcinoma (Fig. 1C).he patient underwent a palliative endoscopic retrogradeolangiopancreatography along with stent placement andxternal radiotherapy with concomitant weekly carboplatinAUC = 2).

Intra-abdominal metastases from squamous cell LCre rather unusual and mostly asymptomatic. Metastaticnvolvement of the pancreas has been more frequentlyeported with small cell LC [2] and usually represents anutopsy finding [3]. Similarly, colonic involvement fromCs has only been reported in a few case reports and issually an incidental finding [1,4]. Symptomatic solitaryastrointestinal metastases from LC consists a rare clini-al entity with dismal prognosis. However, the treatmentf such cases should be individualized depending on theatient’s performance status and the location of metastaticesions.

onflict of interest statement

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252 Letter to the Editor

Fig. 1 (A) Colonoscopy of the first patient found two lesions causing lumen narrowing, while the histologic examination of thesel g car on of

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[ E-mail address: mihkaram@hotmail.com(M.V. Karamouzis)

esions showed metastatic cancer cells from squamous cell lunevealed a mass in the pancreas head. (C) Cytologic examinatirom squamous cell lung carcinoma.

eferences

1] Carroll D, Rajesh PB. Colonic metastases from primary squa-mous cell carcinoma of the lung. Eur J Cardiothorac Surg2001;19:719—20.

2] Maeno T, Satoh H, Ishikawa H, et al. Patterns of pancreaticmetastasis from lung cancer. Anticancer Res 1998;18:2881—4.

3] Chowman NM, Madajewicz S. Management of metastases-induced acute pancreatitis in small-cell carcinoma of the lung.Cancer 1990;65:1445—8.

4] Rouhanimanesh Y, Vanderstighelen Y, Vanderputte S, et al. Intra-abdominal metastases from primary carcinoma of the lung. ArchChir Bel 2001;101:300—3.

Michalis V. Karamouzis ∗

Helena LinardouGiorgos Papadopoulos

rcinoma. (B) Abdomical CT examination of the second patientf mass fine-needle aspiration revealed metastatic cancer cells

Ekaterini BousboukeaDimitra Kanaloupiti

Maria BitzaNikos Spourlis

Dimitrios BafaloukosDepartment of Medical Oncology, Metropolitan Hospital,

Neo Faliro, Athens, Greece

∗ Corresponding author at: Anatolikis Thrakis 20, 15669Papagou, Greece. Tel.: +30 2106528372.

26 September 2006