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Abstract：
Symptomatic colon metastasis from primary lung cancer is rare in clinical practice. We report the case of a 58-year-old patient with advanced lung adenocarcinoma who developed abdominal symptoms, including abdominal distention and difficulty defecating, after immunotherapy and chemotherapy. The patient was diagnosed with lung adenocarcinoma, and systemic positron emission tomography-computed tomography confirmed multiple lymph node, pleural, and adrenal metastases. Molecular detection indicated BRAF V600E mutation and high programmed death-ligand 1 (PD-L1) expression. After first-line anti-programmed cell death protein 1 immunotherapy combined with chemotherapy, the nodes in the chest remarkably diminished. However, it was followed by colon obstruction, incomplete ileus, and bone metastasis. Endoscopic histological examination confirmed adenocarcinoma but could not identify primary or secondary tumors due to insufficient tissue. We performed colon resection to remove the obstruction, and postoperative tissue pathological microscopy confirmed metastasis from the lung adenocarcinoma. We corroborated the BRAF V600E mutation and high PD-L1 expression and supported the molecular features of lung adenocarcinoma. During hospitalization, the patient presented with unbearable pain in the bone metastases, and palliative radiotherapy was administered. Then, the patient received dabrafenib plus trametinib as the second-line therapy. This report discusses the clinical characteristics, pathology, imaging, molecular profile assessments, and treatment of primary lung adenocarcinoma with colon metastasis.
摘要：
原发性肺癌的症状性结肠转移在临床实践中很少见。我们报道了一名58岁的晚期肺腺癌患者出现腹部症状，包括腹胀和排便困难，免疫疗法和化疗后。病人被诊断为肺腺癌,全身正电子发射断层扫描-计算机断层扫描证实了多个淋巴结，胸膜,和肾上腺转移。分子检测提示BRAFV600E突变和高程序性死亡配体1(PD-L1)表达。一线抗程序性细胞死亡蛋白1免疫疗法联合化疗后，胸部的淋巴结明显减少。然而,接着是结肠阻塞,不完全肠梗阻,和骨转移。内镜组织学检查证实腺癌，但由于组织不足而无法识别原发性或继发性肿瘤。我们做了结肠切除切除梗阻,术后组织病理显微镜证实肺腺癌转移。我们证实了BRAFV600E突变和PD-L1高表达，并支持了肺腺癌的分子特征。住院期间,患者在骨转移中表现出难以忍受的疼痛，并给予姑息性放疗。然后，患者接受dabrafenib联合曲美替尼作为二线治疗.本报告讨论了临床特征，病理学,成像,分子概况评估，原发性肺腺癌结肠转移的治疗。
