肺鳞癌结肠黏膜转移一例报告和文献复习

肺癌患者发生结肠转移非常罕见，患者一般无典型症状，晚期可出现腹痛、消化道出血、梗阻、穿孔等症状，并发症和死亡率较高，短期预后差。本中心报道一位63岁男性患者，以"间断咳嗽和右下腹隐痛"就诊，诊断肺鳞状细胞癌并纵隔淋巴结转移和结肠寡转移，经过PD-1免疫治疗，症状改善明显，目前仍在治疗和随访中。     

Colonic metastasis after resection of primary squamous cell carcinoma of the lung:A case report and literature review

Lung cancer is a common malignancy in the world;however symptomatic colonic metastasis from primary lung cancer is rare.A 64-year-old man was originally found poorly differentiated squamous cell carcinoma of right lung and received right lower lobectomy and lymph node dissection.Three years later,the patient presented to our emergency room with the symptom of upper abdominal pain and weight loss.Abdominal palpation and computed tomography scan of the abdomen revealed a large mass measuring 7.6 cm×8.5 cm in the ascending colon.Colonoscopy and biopsy revealed poorly differentiated squamous cell carcinoma with similar morphological pattern to that of the previous lung cancer.Chemotherapy was given and the patient died 5mo later.Lung cancer metastatic to the colon confers a poor prognosis:overall survival ranged from 5 wk to 1year,with a median survival of 3 mo after the diagnosis of the colonic metastasis.     

Metastases to duodenum in cervical squamous cell carcinoma: A case report and review of the literature

Rationale:Metastases to the duodenum in cervical squamous cell carcinoma are extremely rare, with only 7 cases reported in the published English literature.Patient concerns:We present the case of a 66-year-old woman with duodenal metastasis of cervical squamous cell carcinoma who presented with nausea and vomiting within the past 12 days.Diagnosis:Esophagogastroduodenoscopy revealed a circular narrowed 2nd part of the duodenum with congested and edematous mucosa, which was biopsied for a suspected neoplastic lesion. The pathological diagnosis indicated squamous cell carcinoma identical to the original tumor, confirming duodenal metastasis.Interventions:The patient received total parenteral nutrition on admission, but symptoms of jaundice soon appeared in the following week, suggesting infiltration of carcinoma into the common bile duct. After percutaneous transhepatic cholangial drainage was performed, jaundice eased in the following 3 days, and an uncovered self-expandable metallic stent was subsequently inserted into the stenosis of 2nd and 3rd part of the duodenum. Subsequently, the patient''s diet quickly resumed.Outcomes:The patient refused further intervention and was discharged home to continue palliative care at the local hospital.Lessons:Clinicians should be alert to patients’ past medical history to ensure that duodenal metastasis of other tumors is considered in the differential diagnosis. For endoscopists, awareness of such patterns of duodenal stenosis is vital for the accurate recognition of such infrequent diseases.     

肺透明细胞癌1例并文献复习

目的 分析肺透明细胞癌的临床特征、影像学表现及病理诊断要点.方法 报告1例经肺活检病理确诊的肺透明细胞癌病例,并结合文献资料对该病的临床特征、影像学表现及病理诊断要点进行分析.结果 本例患者为女性,45岁,以反复咳嗽2个月为首发症状,胸部CT示两肺多发结节灶合并肺门及纵隔淋巴结肿大,胸腔镜下肺活检病理确诊为原发性肺透明细胞癌.近20年国内外文献报道肺透明细胞癌病例仅27例,其中男性18例,女性9例,平均年龄(55±11)岁.临床表现主要为咳嗽(16/27)、胸痛(12/27)、咯血(10/27).影像学表现以周围型单发结节或团块影多见(22/27),病灶直径0.5～11 cm.该病罕见,属大细胞癌的变异型;确诊多依赖开胸肺组织病理活检,免疫组织化学染色有助于鉴别.结论 肺透明细胞癌的临床表现无特异性;影像学表现以肺部单发结节或团块影多见,亦可为两肺多发和弥漫型;确诊依赖肺组织病理活检,免疫组织化学染色有助于鉴别.     

原发性肺鳞癌回盲部转移1例报道并文献复习

目的 提高对原发性肺癌消化道转移的认识。方法 报道1例原发性肺鳞癌回肓部转移的病例,并对肺癌胃肠道转移相关文献进行复习。结果56岁男性,突发右下腹疼痛伴咳嗽、咯痰,发现头顶部肿物1个月。以“急腹症”为首症就诊,手术病理证实为回盲部鳞癌、癌性穿孔,经支气管镜活检确诊为肺鳞癌,同时合并多部位转移。结论肺癌胃肠道转移较为少见...     

An extremely rare case of pancreatic metastasis of esophageal squamous cell carcinoma

We report a rare case of a 68-year-old male with metachronous pancreatic metastasis that was resected2 years after salvage esophagectomy for local recurrence of esophageal squamous cell carcinoma(ESCC).Two years and 8 mo ago,he had undergone definitive chemoradiotherapy for the lower thoracic ESCC and achieved a complete response.Chemoradiotherapy used the protocol of the Japan Clinical Oncology Group trial 9906.Approximately 8 mo later,he developed a local recurrence of the ESCC and underwent thoracoscopic salvage esophagectomy followed by reconstruction with a conduit colon graft via a subcutaneous route.Recently,a tumor of the pancreatic body was found on routine follow-up computed tomography(CT).The tumor diameter was 15 mm on CT,and the maximum standardized uptake value of the lesion was 5.49at 18F-2-fluoro-2-deoxy-D-glucose positron-emission tomography,strongly suggesting pancreatic cancer.In addition,all tumor markers were within the reference intervals.Therefore,distal pancreatectomy was performed with the resultant histological diagnosis being confirmed as pancreatic metastasis of the ESCC.He was treated with adjuvant chemotherapy,and there has been no evidence of recurrence 9 mo after the surgery.Resection of pancreatic metastasis offers a good prognosis and should be considered for solitary ESCC metastasis.     

Squamous cell carcinoma arising from longstanding colocutaneous fistula： A case report

A 60-year-old female patient suffered unhealed wounds over left flank for around 30 years after surgical removal of left renal stones. Fecal material spilled from the two small openings of the scar, bothered her all day long. During the course of the 30 years, she suffered from intermittent fever, diarrhea and wound pain and presented with malnourished condition. After serial examinations, tumor associated with iatrogenic colo-cutaneous fistula was impressed and she received en bloc resection. Pathology revealed squamous cell carcinoma arising from the fistula with colon and spleen invasion. To the best of our knowledge, no such case has been reported, as yet.     

Gastric metastasis from small cell lung cancer:A case report

Small cell lung cancer(SCLC) represents a group of highly malignant tumors that give rise to early and widespread metastases at the time of diagnosis.The preferential metastatic sites are the brain,liver,adrenal glands,bone,and bone marrow.However,metastases of the gastrointestinal system,especially the stomach,are rare; most cases of stomach metastasis are asymptomatic and,as a result,are usually only discovered at autopsy.We report a case of gastric metastasis originating from SCLC.The patient was a 66-year-old man admitted to our hospital due to abdominal pain.He underwent gastroscopy,with the pathological report of the tissue biopsy proving it to be a small cell cancer.Immunohistochemistry was positive for CD56,synaptophysin,and pan-cytokeratin.These results confirmed the diagnosis of gastric metastasis of a neuroendocrine small cell carcinoma from the lung.     

T790M mutation positive squamous cell carcinoma transformation from EGFR-mutated lung adenocarcinoma after low dose erlotinib: A case report and literature review

Rationale:Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are widely used for the treatment of EGFR mutation positive advanced nonsmall cell lung cancer (NSCLC); however, acquired resistance is known to develop during these treatments. Among these mechanisms, histological transformation is seldom encountered. Although platinum based chemotherapy has been reported to be effective in the treatment of patients with small cell lung cancer transformation, there is a lack of information on the treatment of patients with squamous cell carcinoma (SQ) transformation.Patient Concerns and Diagnosis:An 80-year-old nonsmoking woman was referred to our hospital because of an abnormal shadow on her chest radiograph. Diagnostic bronchoscopy was performed and pathological examination revealed adenocarcinoma. Mutation analysis of the EGFR gene revealed deletion of E746-A750 in exon 19. She refused both surgical treatment and radiation therapy, and preferred periodic radiologic follow-up. Unfortunately, approximately a year and a half after the initial diagnosis, the primary lesion enlarged, and many pleural nodules were newly detected (clinically T4N2M1a, stage IVA).Interventions and Outcomes:Based on EGFR mutation analysis, a reduced dose of daily erlotinib was prescribed, which achieved a partial response and 34 months of progression-free survival (PFS). A repeated biopsy with an endobronchial cryoprobe was performed on the enlarged primary lesion. Pathological examination revealed SQ harboring an identical EGFR mutation with a secondary EGFR T790M mutation. Osimertinib 80 mg once a day was started as second line therapy, which resulted in 8 months of PFS and 15 months of survival.Lesson:The literature review and our report suggest that osimertinib is a promising treatment for NSCLC regardless of histology if T790M is present as an acquired mutation.     

EGFR mutation identifies distant squamous cell carcinoma as metastasis from lung adenocarcinoma

Lung cancer metastasis is typically determined by histologic similarity between distant and primary lesions. Herein, we present a 70-year-old Japanese woman with an adenocarcinoma in her lung and a squamous cell carcinoma in her femur; both tumors had an identical epidermal growth factor receptor mutation, G719S. This indicated that both tumors had a common origin, despite their histologic dissimilarity. The tumor in the femur was thus identified genetically as a lung cancer metastasis. This case suggests that genetic analysis can determine whether a distant lesion is a lung cancer metastasis, particularly when the histology differs from that of the primary lesion.     

肺炎型肺癌1例并文献复习

目的提高对肺炎型肺癌的认识,以期引起临床医生的重视,减少误诊漏诊的发生。方法通过报导1例典型的肺炎型肺癌并进行文献复习,分析和讨论本病的临床表现、影像学特征、诊断、治疗及预后情况。结果肺炎型肺癌影像学主要表现为渗出性病变,但抗炎或抗结核治疗效果差。结论肺炎型肺癌临床表现缺乏典型性,影像学表现酷似肺炎或肺结核,极易被误诊误治,治疗首选手术切除。     

An extremely atypical presentation of esophageal squamous cell carcinoma with pancreatic and hepatic metastases: A case report and overview of the literature

Rationale:Esophageal carcinoma is an aggressive cancer with extremely poor therapeutic outcomes due to its high metastatic potential and a significant risk of recurrence after radical resection. Liver is the most common metastatic target organ of esophageal carcinoma, followed by the lungs, bones, and brain. Few cases of solitary pancreatic and hepatic metastases of esophageal carcinoma have been reported.Patient concerns:We report the case of a 67-year-old male presenting with pancreatic and hepatic lesions. In addition, a friable lesion with an irregular nodular surface in the distal esophagus was detected by esophagogastroduodenoscopy.Diagnosis:Pathohistological examination confirmed esophageal squamous cell carcinoma. The pancreatic lesion was also biopsied via ultrasound-guided fine needle aspiration, which also revealed squamous cell carcinoma. The hepatic lesion was also identified as metastatic carcinoma by magnetic resonance imaging, most likely of the same origin.Interventions:Due to comorbidities that precluded surgery, the patient was administered adjuvant therapy and a multidisciplinary decision was made for palliative care.Outcomes:The patient died 1 month later due to multiorgan failure caused by hemorrhage from a peptic ulcer.Conclusion:To our knowledge, this is only the sixth case of pancreatic metastasis of esophageal squamous cell carcinoma. This case report suggests to clinicians the importance of considering potential comorbidities in every patient with advanced cancer, such as gastric ulcer and cachexia.     

Bilateral adrenal metastasis of renal cell carcinoma 4 years after radical nephrectomy: A case report and review of literature

Rationale:Renal cell carcinoma (RCC) almost metastasizes to every organ, the possibility of adrenal metastasis is relatively low in patients that have undergone radical nephrectomy, only a few cases of bilateral adrenal metastasis are reported on literature. Although surgical treatment of metastases from RCC is preferred and contributes to the rate of survival, it is considered challenging to manage such cases due to the rarity of bilateral metastasis to the adrenal glands.Patient concerns:A 64-year-old Manchus female presented with an incidental ultrasonic finding of a left adrenal mass 4 years after radical nephrectomy for left renal cell carcinoma.Diagnosis:Abdominal contrast enhanced CT scan revealed bilateral adrenal masses, suggesting metastatic lesion. Examinations indicated neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography/Computed Tomography (PET/CT) scan except high radioactive uptake in bilateral adrenal glands.Interventions:Metachronous bilateral adrenalectomy was taken and laparoscopic right adrenalectomy was first performed. She was discharged home on third postoperative day. Pathological examination revealed metastatic renal cell carcinoma. Two months later she was performed laparoscopic left adrenalectomy.Outcomes:The patient healed without obvious complications and no tumor recurrence.Lessons:Bilateral metastatic adrenal recurrence from RCC is very rare. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally. Surgical intervention is a wise option for these patients that may improve survival, and metachronous bilateral adrenalectomy is proved to be safe and effective.     

Aggressive progression of granulocyte colony-stimulating factor producing squamous cell carcinoma of the esophagus: case report and literature review

We report a case of a 69-year-old man who was diagnosed to have granulocyte colony-stimulating factor (G-CSF)-producing esophageal squamous cell carcinoma, based on a histological examination of endoscopic biopsy specimens. A high serum level of leukocytes and G-CSF was noted. Moreover, immunohistochemical examination revealed that the tumor cells were positive for antibodies against G-CSF. Palliative radiation therapy was performed because of existing distant metastasis at the time of presentation, and the patient died of tumor progression 7 months after the initial diagnosis. To the best of our knowledge, only five cases with G-CSF-producing squamous cell carcinoma have been described in the English literature, including our present case. Because many cytokines induced by G-CSF-producing tumors contribute to tumor growth and aggressive inflammation, these patients might have a poor prognosis. G-CSF-producing tumor is extremely rare; however, we should consider a differential diagnosis for such disease when a patient shows a high leukocyte count with no evidence of systemic infection or hematological disease.