Abstract：
BACKGROUND: Gastrointestinal (GI) metastases in lung cancer rarely occur.
METHODS: We report here the case of a 43-year-old male active smoker who was admitted to our hospital for cough, abdominal pain and melena. Initial investigations revealed poorly differentiated adenocarcinoma of the superior-right lobe of the lung: positive for thyroid transcription factor-1 and negative for protein p40 and for antigen CD56, with peritoneal, adrenal and cerebral metastasis, as well as anemia requiring major transfusion support. Over 50% of cells were positive for PDL-1, and ALK gene rearrangement was detected. GI endoscopy showed a large ulcerated nodular lesion of the genu superius with active intermittent bleeding, as well as an undifferentiated carcinoma with positivity for CK AE1/AE3 and TTF-1, and negativity for CD117, corresponding to metastatic invasion originating from lung carcinoma. Palliative immunotherapy with pembrolizumab was proposed, followed by targeted therapy with brigatinib. Gastrointestinal bleeding was controlled with a single 8Gy dose of haemostatic radiotherapy.
CONCLUSIONS: GI metastases are rare in lung cancer and present nonspecific symptoms and signs but no characteristic endoscopic features. GI bleeding is a common revelatory complication. Pathological and immunohistological findings are critical to diagnosis. Local treatment is usually guided by the occurrence of complications. In addition to surgery and systemic therapies, palliative radiotherapy may contribute to bleeding control. However, it must be used cautiously, given a present-day lack of evidence and the pronounced radiosensitivity of certain gastrointestinal tract segments.
METHODS: We report here the case of a 43-year-old male active smoker who was admitted to our hospital for cough, abdominal pain and melena. Initial investigations revealed poorly differentiated adenocarcinoma of the superior-right lobe of the lung: positive for thyroid transcription factor-1 and negative for protein p40 and for antigen CD56, with peritoneal, adrenal and cerebral metastasis, as well as anemia requiring major transfusion support. Over 50% of cells were positive for PDL-1, and ALK gene rearrangement was detected. GI endoscopy showed a large ulcerated nodular lesion of the genu superius with active intermittent bleeding, as well as an undifferentiated carcinoma with positivity for CK AE1/AE3 and TTF-1, and negativity for CD117, corresponding to metastatic invasion originating from lung carcinoma. Palliative immunotherapy with pembrolizumab was proposed, followed by targeted therapy with brigatinib. Gastrointestinal bleeding was controlled with a single 8Gy dose of haemostatic radiotherapy.
CONCLUSIONS: GI metastases are rare in lung cancer and present nonspecific symptoms and signs but no characteristic endoscopic features. GI bleeding is a common revelatory complication. Pathological and immunohistological findings are critical to diagnosis. Local treatment is usually guided by the occurrence of complications. In addition to surgery and systemic therapies, palliative radiotherapy may contribute to bleeding control. However, it must be used cautiously, given a present-day lack of evidence and the pronounced radiosensitivity of certain gastrointestinal tract segments.
摘要：
背景：肺癌的胃肠道（GI）转移很少发生。
方法：我们在此报告一例43岁男性活跃吸烟者因咳嗽入院，腹痛和黑便.初步调查显示肺右上叶的低分化腺癌：甲状腺转录因子-1阳性，蛋白p40和抗原CD56阴性，腹膜，肾上腺和脑转移，以及需要大量输血支持的贫血。超过50％的细胞对PDL-1呈阳性，并检测到ALK基因重排。胃肠内镜检查显示上甲膝有一个大的溃疡状结节性病变，伴有活动性间歇性出血，以及CKAE1/AE3和TTF-1阳性的未分化癌，CD117阴性的未分化癌，对应于源自肺癌的转移性侵袭。提出了使用pembrolizumab进行姑息性免疫疗法，其次是布格替尼的靶向治疗。通过单次8Gy剂量的止血放疗控制消化道出血。
结论：胃肠道转移在肺癌中很少见，并且存在非特异性症状和体征，但没有特征性的内镜特征。消化道出血是一种常见的并发症。病理和免疫组织学发现对诊断至关重要。局部治疗通常以并发症的发生为指导。除了手术和全身治疗，姑息性放疗可能有助于控制出血。然而,必须谨慎使用，鉴于目前缺乏证据和某些胃肠道节段明显的放射敏感性。
方法：我们在此报告一例43岁男性活跃吸烟者因咳嗽入院，腹痛和黑便.初步调查显示肺右上叶的低分化腺癌：甲状腺转录因子-1阳性，蛋白p40和抗原CD56阴性，腹膜，肾上腺和脑转移，以及需要大量输血支持的贫血。超过50％的细胞对PDL-1呈阳性，并检测到ALK基因重排。胃肠内镜检查显示上甲膝有一个大的溃疡状结节性病变，伴有活动性间歇性出血，以及CKAE1/AE3和TTF-1阳性的未分化癌，CD117阴性的未分化癌，对应于源自肺癌的转移性侵袭。提出了使用pembrolizumab进行姑息性免疫疗法，其次是布格替尼的靶向治疗。通过单次8Gy剂量的止血放疗控制消化道出血。
结论：胃肠道转移在肺癌中很少见，并且存在非特异性症状和体征，但没有特征性的内镜特征。消化道出血是一种常见的并发症。病理和免疫组织学发现对诊断至关重要。局部治疗通常以并发症的发生为指导。除了手术和全身治疗，姑息性放疗可能有助于控制出血。然而,必须谨慎使用，鉴于目前缺乏证据和某些胃肠道节段明显的放射敏感性。
