Upper gastrointestinal bleeding as the initial manifestation of lung adenocarcinoma metastatic to the stomach

Background

Metastasis to the stomach rarely occurs, and gastric metastasis as an initial sign of cancer occurs even less frequently. We report herein a case of lung adenocarcinoma in which the patient's initial symptom was secondary to gastric metastasis.

Case

A 49-year-old woman was admitted to the hospital with complaints of melena, which had developed 3 days previously. Endoscopy revealed a gastric ulcer with bleeding. The endoscopic biopsy was consistent with adenocarcinoma. The initial clinical impression was gastric adenocarcinoma; however, a chest radiograph revealed right hilar enlargement. Bronchoscopic biopsy confirmed adenocarcinoma. Immunohistochemical studies in both specimens were positive for thyroid transcription factor-1 and thus suggestive of primary lung adenocarcinoma. The patient died 12 months after initial diagnosis.

Conclusion

Although the initial manifestation was unusual, clinicians should be aware that malignant gastric ulcers may represent as an initial sign of underlying lung adenocarcinoma and an immunohistochemical examination for thyroid transcription factor-1 should be obtained if metastatic gastric tumor from the lung is suspected. Optimal treatment rests on making an accurate diagnosis.