Surgical indication and management of obstructive colonic metastasis from primary lung adenocarcinoma: report of a case and review of the literature

IF 0.7 Q4 SURGERY Surgical Case Reports Pub Date : 2024-09-18 DOI:10.1186/s40792-024-02016-3
Mai Watanabe, Shingo Tsujinaka, Tomoya Miura, Yoshihiro Sato, Yoh Kitamura, Kentaro Sawada, Atsushi Mitamura, Hiroto Sakurai, Noriko Kondo, Kazuhiro Takami, Kuniharu Yamamoto, Toru Nakano, Yu Katayose, Naruo Yoshimura, Chikashi Shibata
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Abstract

Colonic metastasis from lung cancer is very rare and is typically associated with poor prognosis. Herein, we report the case of a patient who achieved intermediate-term survival using a multimodal treatment approach, including chemotherapy, immunotherapy, radiotherapy, and surgical resection for obstructive colonic metastasis from primary lung adenocarcinoma. A woman in her 50s presented with anemia and a positive fecal occult blood test. Computed tomography revealed a tumor in the right upper lobe of the lung with mediastinal lymphadenopathy and wall thickening in the transverse colon. Colonoscopy revealed a stricture involving 50% of the colonic lumen. Biopsy revealed a poorly differentiated adenocarcinoma positive for CK-7 and TTF-1, very focally positive for napsin A, and negative for CK-20 and CDX-2. Furthermore, positron emission tomography/CT (PET/CT) showed a high maximum standardized uptake value (SUVmax) of 8.2 in the iliac bone. Based on these findings, the patient was diagnosed with primary lung adenocarcinoma with simultaneous metastasis to the transverse colon and iliac bone (cT4N3M1c, cStage IVB). After receiving first-line chemotherapy with atezolizumab, pemetrexed, and carboplatin, the tumors shrank after 4 courses. Subsequently, the patient received maintenance therapy with atezolizumab and pemetrexed. However, the tumor enlarged after 10 courses. Second-line chemotherapy with docetaxel and ramucirumab (3 courses) failed to achieve tumor reduction. Colonoscopy revealed an impassable colonic tumor. Nineteen months after diagnosis, surgery was planned for imminent intestinal obstruction. We determined that the colonic tumor was resectable, because laparoscopic exploration revealed no other metastases. The tumor was resected by partial colectomy with ileocolonic anastomosis. The postoperative course was uneventful. Pathological examination revealed a resection margin that was negative for malignancy, and the histological type was consistent with metastatic lung adenocarcinoma. The patient then received nab-paclitaxel therapy; however, she developed symptoms of superior vena cava syndrome after 3 courses. The patient received palliative irradiation (30 Gy/10 fr) followed by nivolumab. She soon developed a solitary brain metastasis, and stereotactic irradiation was planned. After 3 courses of nivolumab, the metastasis was reduced significantly, and stereotactic brain irradiation was canceled. The lung tumor and mediastinal lymphadenopathy gradually shrank, and the patient survived for 13 months after surgery without disease progression. In this case, surgical resection of colonic metastasis from primary lung adenocarcinoma may have contributed to the short-term prognosis as a bridge-to-next available multimodal treatment.
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原发性肺腺癌梗阻性结肠转移的手术指征和治疗:一例病例报告和文献综述
肺癌结肠转移非常罕见,通常预后较差。在此,我们报告了一例采用多模式治疗方法(包括化疗、免疫治疗、放疗和手术切除)治疗原发性肺腺癌阻塞性结肠转移的患者,该患者获得了中期生存。一名 50 多岁的妇女因贫血和大便潜血试验阳性就诊。计算机断层扫描显示右肺上叶有肿瘤,纵隔淋巴结病变,横结肠壁增厚。结肠镜检查发现,50%的结肠管腔出现狭窄。活组织检查发现,分化较差的腺癌,CK-7 和 TTF-1 阳性,napsin A 局灶阳性,CK-20 和 CDX-2 阴性。此外,正电子发射断层扫描/CT(PET/CT)显示,髂骨的最大标准化摄取值(SUVmax)高达 8.2。根据这些结果,患者被诊断为原发性肺腺癌,并同时转移至横结肠和髂骨(cT4N3M1c,c IVB 期)。在接受了阿特珠单抗、培美曲塞和卡铂的一线化疗后,肿瘤在 4 个疗程后缩小。随后,患者接受了阿替珠单抗和培美曲塞的维持治疗。然而,10 个疗程后肿瘤增大。多西他赛和雷莫芦单抗的二线化疗(3 个疗程)未能使肿瘤缩小。结肠镜检查发现结肠肿瘤无法通过。确诊后19个月,因即将发生肠梗阻而计划进行手术。我们确定结肠肿瘤可以切除,因为腹腔镜检查没有发现其他转移灶。我们通过部分结肠切除术和回结肠吻合术切除了肿瘤。术后恢复顺利。病理检查显示切除边缘恶性程度为阴性,组织学类型符合转移性肺腺癌。患者随后接受了纳布-紫杉醇治疗,但三个疗程后出现了上腔静脉综合征症状。患者接受了姑息性照射(30 Gy/10 fr),随后又接受了 nivolumab 治疗。不久,她出现了单发脑转移瘤,于是计划进行立体定向照射。经过3个疗程的尼夫单抗治疗后,转移灶明显缩小,于是取消了脑立体定向照射。肺部肿瘤和纵隔淋巴结病变逐渐缩小,患者术后存活了13个月,病情未见进展。在本病例中,原发性肺腺癌结肠转移灶的手术切除可能有助于短期预后,是通往下一个可用的多模式治疗的桥梁。
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