A case of squamous cell lung carcinoma with gastric metastasis.

To the Editor: Lung cancer usually metastasizes the bone, adrenal glands, and brain. It is uncommon in the digestive system, particularly in the stomach. The most common sites of primary malignancy in patients who presented with gastric metastasis is malignant melanoma, breast cancer, and lung cancer. (1) Reported incidences of lung cancer metastasis to the stomach vary between 0.2 to 0.4%, in which metastasis of large cell carcinoma was the most common (3.7%), followed by adenocarcinoma (2.4%), small cell carcinoma (1.7%), and squamous cell carcinoma (0.7%). (1,2) We herein describe an unusual case of gastric metastasis in a patient with squamous cell carcinoma of the lung.

A 66-year-old smoker (47 pack-year) male patient was diagnosed with pulmonary squamous cell carcinoma by bronchosopic biopsy, clinically staged as T2N2M1 with a separate tumor nodule in an ipsilateral different lobe (Fig. A). He had received initially six cycles of paclitaxel and carboplatin combination therapy. Partial remission was achieved. A month later disease progression was documented by chest X-ray (Fig. B) and computed tomography of thorax, and the patient was recruited in the ISEL (Iressa Survival Evaluation in Lung cancer) protocol. On the third month of the Iressa therapy, the tumor size was significantly reduced (Fig. C). But he experienced severe epigastric pain and vomiting. Physical examination revealed epigastric tenderness. Upper endoscopic evaluation revealed Grade 1 esophagitis, erosive and atrophic pangastritis. Upper endoscopic biopsy confirmed a diagnosis of squamous cell carcinoma metastasis (Fig. D). This was histologically identical with the primary tumor. Abdominal ultrasonography showed multiple metastatic lesions in the liver. No further treatment was recommended. His respiratory condition gradually worsened, and he died two months later.

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Gastric metastases of lung carcinoma are considered to be rare probably because many are often asymptomatic. (3) They may present with pain or with upper gastrointestinal bleeding. (4,5) Survival after development of gastrointestinal involvement is generally poor.

Sibel Alpar, MD

Ozlem Kar Kurt, MD

Nazire Ucar, MD

Osman Orsel, MD

Department of Chest Diseases

Ataturk Chest Disease and Chest Surgery

Education and Research Hospital

Ankara, Turkey

Gulden Aydog, MD

Department of Pathology

Yuksek Ihtisas Hospital

Ankara, Turkey

Bahar Kurt, MD

Department of Chest Diseases

Abant Izzet Baysal University 

Bolu, Turkey

References

1. Kim HS, Jang WI, Hong HS, et al. Metastatic involvement of the stomach secondary to lung carcinoma. J Korean Med Sci 1993;8:24-29.

2. Ryo H, Sakai H, Ikeda T. et al. [Gastrointestinal metastasis from lung cancer]. Nihon Kyobu Shikkan Gakkai Zasshi 1996;34:968-972.

3. Antler AS. Ough Y. Pitchumoni CS. et al. Gastrointestinal metastases from malignant tumors of the lung. Cancer 1982;49:170-172.

4. Altintas E, Sezgin O. Uyar B, et al. Acute upper gastrointestinal bleeding due to metastatic lung cancer: an unusual case. Yonsei Med J 2006;47:276-277.

5. Barrio J, Arriola JA, San Vicente MT, et al. [Bleeding of the upper digestive tract due to gastric metastasis of squamous lung carcinoma]. Gastroenterol Hepatol 1999;22:405-407.