CASE REPORT Open Access Acute Small Bowel Obstruction: A .

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have higher incidence of GI metastases. McNeill et al. [6] reported that12 of 31 (39.0%) patients with large cell carcinoma hadsmall bowel metastases. Yoshimoto et al. [4] evaluated470 cases of GI metastases from primary lung cancerover 33 years and their data showed that 30% of caseswere large cell carcinoma. Patients with large cell carcinoma had a significantly higher rate of GI metastases(P 0.004, odds ratio 3.524) compared with patients withnon-large cell carcinoma. Because of the difficulty inearly detection of GI diseases, the diagnosis of smallbowel metastases was often delayed before it presentedwith life-threatening complications, which frequentlyrequired emergency surgeries [1,13]. Kim evaluated theCT scan findings in 28 patients with gastrointestinalmetastasis from lung cancer and found 5/26 patients hadtwo lesions and 21 patients had only one lesion. Theshape of GI lesion varied on CT scans, presenting as wallthickening in 14 cases, an intraluminal polypoid mass in14 cases, and an exophytic mass in the other three cases[14]. PET is more accurate than CT or other conventional imaging methods for the diagnosis of metastaticmalignant sites. However, the role of PET in the diagnosis of lung cancer GI metastasis is still controversialbecause of the lack of enough clinical cases. Small bowelmetastases from primary lung cancer were usuallyFigure 4 The abdominal computerized tomography scan revealed metastatic tumor mass of jejunum (a and b).

Song et al. World Journal of Surgical Oncology 2012, 10:26http://www.wjso.com/content/10/1/26Page 4 of 5Figure 5 Microscopic images of jejunum resection (a) hematoxylin-eosin staining, 100 showing groups of large anaplastic tumorcells invading the lamina serosa; (b) immunoperoxidase 400 showing CK7 cytoplasmic positivity on a jejunum resection tissue.confirmed by pathological analysis, with the help ofimmunohistochemical staining of TTF-1, CDX2, CK7and CK20, to differentiate the primary small boweltumor from metastases of lung cancer [2].So far, surgical resection is the mainstay treatment forsmall bowel metastases from large cell carcinoma of thelung. Individualized treatment may also be helpful.Advances in chemotherapy and supportive care may leadto the improvement of the survival rate for these lungcancer patients. According to the report from a phase IIIstudy (JMDB trial), overall survival was statistically higherin patients with large cell carcinoma histology whoreceived treatment of cisplatin plus pemetrexed versuscisplatin plus gemcitabine, the latter being the standardfirst-line regimen of non-small cell lung cancer; n 153;10.4 months v 6.7 months, respectively [15].In our case, small bowel obstruction was the initialclinical symptom for this male patient. Primary lunglarge cell carcinoma was confirmed by a pathologist andat the same time small bowel and left adrenal metastaseswere suggested by CT scan (stage IV). Unfortunately thepatient did not benefit from an emergency operation andchemotherapy. Multiple brain metastases soon developedand the patient died 64 days after the diagnosis. The histological type of large cell carcinoma of the lung, metastases in multiple sites, heavy tumor load and surgicalstroke might be the reasons of the poor prognosis. During the clinical course, physicians should be aware of gastrointestinal tract metastases if the patient with lungcancer presents with gastrointestinal tract symptoms.Progression of examinations for screening small boweldiseases will be helpful for doctors to diagnose morecases of small bowel metastases from lung cancer in thefuture. Earlier resection of the gastrointestinal metastasesto alleviate the symptoms and decrease tumor load maybe beneficial to the patients and achieve a better prognosis [11,16-18].ConclusionIn conclusion, small bowel metastases from lung cancerare not uncommon and occur only in the advancedstage of lung cancer, particularly if patients have the histological type of large cell lung carcinoma. Physiciansshould keep

tion or bleeding could be the results of small bowel invol-vement. We report one case of metastatic large cell carcinoma of the lung with the primary presentation of acute small bowel obstruction. The current management plan, as well as prognosis of this patient is discussed. GI m

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