Document Detail


Hemorrhagic small intestine cancer with solitary pulmonary metastasis initially presented as suspected primary lung cancer: an autopsy report.
MedLine Citation:
PMID:  18432067     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cancer of the small intestine presenting with a solitary pulmonary metastasis is rare. Diagnosis and treatment of hemorrhagic small intestinal disease is clinically problematic due to its anatomic aspect, especially after multiple laparotomies. The case that we present here was a 79-year-old man who was initially diagnosed with suspected T2N2M0 lung cancer. After non-diagnostic results on two bronchoscopic biopsies and computed tomography-guided needle biopsy, he was admitted for thoracoscopic biopsy and possible curative operation. The patient had a history of multiple laparotomies for gastric ulcer and had no abdominal symptoms. A fecal occult blood test was positive; this was thought to be because of persistent bloody sputum. During the preoperative evaluation period, massive intestinal hemorrhage occurred. Intestinal tumor was identified by double-balloon enteroscopy and emergency laparotomy was performed to control the bleeding. The histopathological diagnosis was metastatic adenocarcinoma. However, intestinal bleeding started again. His systemic status deteriorated progressively, resulting in death. Autopsy revealed a large polypoid tumor with hemorrhagic necrosis in the jejunum that was histologically and immunohistochemically diagnosed as primary poorly differentiated adenocarcinoma in the small intestine. Multiple small submucosal tumors with central ulceration were confirmed as intramural metastases. A lung mass in the right lower lobe was diagnosed as a metastatic lesion. In the diagnosis and treatment of the disease, we faced several clinically difficult problems. We here describe in detail the clinical course and the diagnostic and therapeutic difficulties of this rare case, with some references to the literature.
Authors:
Takashi Iwata; Kiyotoshi Inoue; Sachiko Kiriike; Nobuhiro Izumi; Shinjiro Mizuguchi; Takuma Tsukioka; Ryuhei Morita; Noritoshi Nishiyama; Masashi Takemura; Harusi Osugi; Kenichi Wakasa; Shigefumi Suehiro
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Osaka city medical journal     Volume:  53     ISSN:  0030-6096     ISO Abbreviation:  Osaka City Med J     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2008-04-24     Completed Date:  2008-05-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376413     Medline TA:  Osaka City Med J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  109-16     Citation Subset:  IM    
Affiliation:
Department of Thoracic Surgery, Osaka City University Hospital, Japan. taiwata@med.osaka-cu.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adenocarcinoma / complications*,  diagnosis,  secondary*
Aged
Disease Progression
Fatal Outcome
Gastrointestinal Hemorrhage / diagnosis,  etiology*
Humans
Jejunal Neoplasms / complications*,  diagnosis,  secondary*
Lung Neoplasms / diagnosis,  pathology*
Male

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