metastatic polips

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Cli i l J l f O l N i V l 14 N b 6 L h Edi 683

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Digital Object Identifer: 10.1188/10.CJON.683-684

Letters to the editor deborah K. Mayer, Phd, rN, aoCN®, FaaN—editor

Metastatic Polyps in the Hepatic

Flexura of the Colon

Metastatic tumors o the gastrointes-

tinal (GI) tract are uncommon. Lung

cancer very rarely metastasizes to the

GI tract, but when in does, the small in-

testine is the most requent site (Kim et

al., 2009). Among lung cancer subtypes,large and squamous cell carcinomas

are the most common to metastasize to

the GI tract (Antler, Ough, Pitchumoni,

Davidian, & Thelmo, 1982; Kim et al.,

2009). Small cell lung cancer metastasis

to the GI tract has been reported only

rarely. Herein we present a case report

o metastatic involvement o the GI tract.

To our knowledge, this is the rst report

o small cell lung cancer metastasis to the

stomach and colon.

A 72-year-old woman was admitted with complaints o atigue, weight loss,

and progressive numbness o her ex-

tremities. She was a 15 pack-year smok-

er. Physical examination revealed mild

weakness o distal extremities. Labo-

ratory tests showed elevated levels o

alkaline phosphatase (810 IU/L), gamma

glutamyl transerase (334 IU/L), aspartate

amino transerase (102 IU/L), alanine

transaminase (124 IU/L), creatine kinase

(600 IU/L), CA 15–3 (483 U/ml), and CA

19–9 (1,504 U/ml). A chest radiogram was normal. Ultrasonography revealed

multiple metastatic lesions in the liver. To

detect the origin o the metastasis, upper

and lower GI tract endoscopies were per-

ormed. The upper GI endoscopy showed

atrophic gastritis, so biopsies were taken

rom the corpus. At colonoscopy, two

masses with a diameter o 30 mm at

the proximal and distal part o hepatic

lexura were detected (see Figure 1).

Sometimes polyps may not be seen, but

when colonoscopy is perormed by nurs-

es experienced with polyp detection, the

rate increases. Histopathologic examina-

tion o the gastric and colonic samples

revealed metastasis o small cell lung can-

cer. Computed tomography o the thorax

showed inltration at the right lower lobe

o the lung. Bone scintigraphy showed

vertebral metastases. Electromyography

revealed sensory motor peripheral neu-ropathy. Chemotherapy with cisplatin

and etoposid was initiated. Although the

patient had completed ve sessions o

her chemotherapy regimen, she died o

brain metastasis our months ater being

diagnosed with lung cancer.

The most common metastatic region

o lung cancer is the bone, liver, adrenal

gland, bone marrow, and brain. Although

GI tract metastasis o lung cancer has

been reported at about 10%, the reported

incidence o symptomatic GI metastasis is

less than 0.5% (Berger et al., 1999).

Clinical presentation o colonic me-tastasis includes obstruction, bleeding,

intussusceptions, peroration, and stula.

In this case study, the patient was ree o

any GI complaints and lung cancer was

diagnosed ater sampling rom gastric

and colonic lesions.

Note. The mass was about 30 mm in diameter and erosion was present at the top.

Figure 1. Mass in the Distal Portion of Hepatic Flexuraat Colonoscopy

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684 D b 2010 V l 14 N b 6 Cli i l J l f O l N i

The shape o metastatic lesions o

the GI tract may vary and may present

as luminal narrowness because o wall

thickening and exophytic and intralumi-

nal polypoid masses. Interestingly, this

patient had two lesions at the hepatic

fexura with the same morphologic ea-

tures.

One o the surprising ndings in this

case study was gastric metastasis with-out macroscopic endoscopic lesions.

The gastric biopsies were taken to con-

rm the diagnosis o atrophic gastritis.

Diuse microscopic involvement may

be present in cases with multiorgan

metastasis.

Levels o tumor markers, including CA

19–9 and 15–3, were extremely high in

this case and may increase in other ma-

lignancies, including pancreas and biliary

tract tumors and breast carcinoma. All o

these tumors were excluded in the pres-ent case accordingly. In addition, high

serum levels o the markers have been

reported in primary adenocarcinoma

o the lung rather than small cell lung

cancer (Bearz et al., 2007; Rottenberg,

Nisman, & Peretz, 2009).

In conclusion, GI tract metastasis o

lung cancer is rarely detected at colonos-

copy. Metastasis to the colon may present

as polyp ormation.

Seyfettin Köklü, MD

Associate Professor

Department of Gastroenterology

Erdem Koçak, MD

Research Fellow


Adnan Tas, MD

Research Fellow


İ brahim Bıyıko ğ lu, MD

Specialist


Hüseyin Üstün, MD

Associate Professor

Department of Pathology

Ankara Education and Research

Hospital

Ankara, Turkey

Author Contact: Adnan Tas, MD, can be reached

at [email protected], with copy to editor at

[email protected].

References

Antler, A.S., Ough, Y., Pitchumoni, C.S., Da-

vidian, M., & Thelmo, W. (1982). Gastroin-

testinal metastases rom malignant tumors

o the lung. Cancer, 49, 170–172.

Bearz, A., Talamini, R., Vaccher, E., Spina,

M., Simonelli, C., Stean, A., . . . Tirelli,

U. (2007). MUC-1 (CA 15–3 antigen) as a

highly reliable predictor o response to

EGFR inhibitors in patients with bron-

chioloalveolar carcinoma: An experience

on 26 patients. International Journal of

Biological Markers, 22, 307–311.

Berger, A., Cellier, C., Daniel, C., Kron, C.,

Riquet, M., Barbier, J.P., . . . Landi, B.

(1999). Small bowel metastases rom pri-

mary carcinoma o the lung: Clinical nd-

ings and outcome. American Journal of

Gastroenterology, 94, 1884–1887.

Kim, S.Y., Ha, H.K., Park, S.W., Kang, J.,

Kim, K.W., Lee, S.S., . . . Kim, A.Y. (2009).

Gastrointestinal metastasis rom primary

lung cancer: CT indings and clinico-

pathologic eatures. American Journal

of Roentgenology, 193, W197–W201. doi:

10.2214/AJR.08.1907

Rottenberg, Y., Nisman, B., & Peretz, T.

(2009). Extreme high levels o CA19–9

associated with adenocarcinoma o the

lung. Israel Medical Association Jour-

nal, 11, 116–117.



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