Archives of Clinical Pathology

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Case Report,  Arch Clin Pathol Vol: 4 Issue: 5

Caecal Metastasis: An Exceptional Manifestation Mode Revealing Small Cell Lung Carcinoma: Clinical Case and Review of the Literature

W Ben Makhlouf1, Z Dahmani2, M Hamdani1, J Elghoul3, K Bel Hadj Ali1 and Abdelmajid Khabir1*

1Department of Pathology, Chu Habib Bourguiba of Medicine, Sfax, Tunisia

2Department of Gastroenterology and Hepatology, Chu Habib Bourguiba of Medicine, Sfax, Tunisia

3Department of pneumology, Chu Habib Bourguiba of Medicine, Sfax, Tunisia

*Corresponding author: Abdelmajid Khabir, Department of Pathology, Chu Habib Bourguiba of Medicine, Sfax, Tunisia, Tel: +21698656812; E-mail: [email protected]

Received date: September 14, 2021; Accepted date:  September 30, 2021; Published date: October 11, 2021

Abstract

Lung carcinoma is the leading cause of death worldwide. Almost 50% of patients present with distant metastasis at the moment of diagnosis. The most common metastasis sites are the lymph nodes, the liver, the adrenal glands, the bones, and the brain. However, Gastro-Intestinal Tract (GIT) metastasis from primary lung carcinoma is a rare phenomenon and it is considered a late stage of the disease, generally detected in patients with a documented previous history of a primary lung malignancy. However, the finding of a lung cancer initially manifesting with GI-tract involvement is extremely rare and it is usually reported in the literature in isolated case reports. This case study involves a 70 year-old-man, initially presenting with digestive symptoms related to caecal metastasis from primary lung carcinoma.

Keywords: Lung carcinoma; Small cell carcinoma; Caecal metastasis

Introduction

Gastro-Intestinal Tract (GIT) metastases from lung cancer are extremely rare. They are usually asymptomatic and often discovered at a late stage of the disease or at autopsy studies. We here in report a case of a patient with caecal metastasis from small cell lung carcinoma presenting initially with abdominal symptoms. Histopathological examination and immunohistochemical staining of the caecal biopsies confirmed the diagnosis of metastatic neuroendocrine small cell lung carcinoma.

Case report

A 70-year-old male patient with no pathological history, a former cigarette smoker (40 pack-years) who quitted smoking 2 years earlier, consulted our emergency department for cramp-type left flank pain associated with constipation and vomiting progressing for 2 months. The patient also reported asthenia, anorexia, and weight loss. Clinical examination showed generalized abdominal defense. Abdominal ultrasound showed a solid caecal mass with irregular contour, hypo echoic internal echo texture, measuring 6 × 5 × 4 cm with multiple enlarged lymph nodes, suggesting a secondary origin. Abdominal CT scan was performed and showed a large caecal mass with exophytic development and heterogeneous enhancement measuring about 45 × 46 × 50 mm in contact with the last ileal loop that appeared to be invaded and it was associated with multiple loco regional necrotic lymphadenopathies in continuity with the tumor and in para aortic region (Figure 1).

 

Figure 1: (A) Solid caecal mass with irregular contour with multiple enlarged lymph nodes. (B,C) Abdominal CT scan: Large caecal mass with exophytic development and heterogeneous enhancement.

Diagnosis based on the clinical and radiological findings was in favor of colonic tumor. A colonoscopy under general anesthesia was performed and showed an ulcerative and stenosing tumor of the caecum. Biopsies were taken.

Pathological examination revealed a largely ulcerated colonic mucosa with carcinomatous proliferation, arranged in small and sometimes medium cell clusters with reduced cytoplasm. The nuclei were monomorphic with a salt and pepper appearance. These tumor cells were in some places crushed and poorly delimited. Mitoses were numerous. The stromal was reduced, and having neuroendocrine type (Figure 2).