An elderly man presented with chest pain and shortness of breath on a background of left lower lobe small cell lung cancer, previously treated with chemotherapy. Blood test showed iron deficiency anaemia requiring transfusion. An oesophagogastroduodenoscopy was performed, highlighting an external compression to the distal stomach and a 15 mm round lesion, with a central ulcerated depression and rolled edges in D3, which was suspicious of malignancy (figure 1). Target biopsies (figure 2) confirmed the malignant nature of the lesion with features of small cell neuroendocrine carcinoma, in keeping with a lung metastasis.
Figure 1.
Oesophagogastroduodenoscopy showing a tumour deposit with a rolled edge and ulcerated centre found in D3.
Figure 2.
(A) H&E X15: Duodenal mucosa with identifiable villi (V), infiltrated by crushed blue small-sized tumour cells (circle), consistent with a poorly differentiated neuroendocrine carcinoma of small cell type. Small cell lung carcinoma is a fragile tumour and often crushed during biopsy. The arrow indicates the presence of lymphatic invasion. (B) Immunostaining for synaptophysin X15: The neoplastic cells are positive for neuroendocrine marker synaptophysin.
Gastrointestinal metastases from a lung cancer primary are rare, with a clinical prevalence of 0.19%.1 The small bowel is the most common gastrointestinal metastatic site and tumours are spread via the haematogenous and lymphatic routes. Patients with small bowel involvement usually present with bowel perforation or gastrointestinal bleeding. Diagnosis is made through oesophagogastroduodenoscopy or emergency laparotomy and the average time between discovery of gastrointestinal metastasis to death is 3–4 months.2–4
Acknowledgments
Dr Tuvinh Luong—Consultant Histopathologist, Dr Alexander Stevenson—Gastroenterology Registrar.
Footnotes
Contributors: PA: conceptualisation, data curation, resources, validation, writing. JL: conceptualisation, data curation, resources, validation, writing. CM: conceptualisation, supervision, validation. AM: conceptualisation, editing, supervision, validation.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
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References
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