Digestive and Liver Disease 46 (2014) 474
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Upper gastrointestinal tract metastasis from lung cancer Mohammad Esmadi ∗ , Dina S. Ahmad, Yumei Fu, Hazem T. Hammad Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO, USA
A 62 year-old female with a history of smoking presented with abdominal pain, melena, and cough for one month. She was hypotensive and tachycardic. Her haemoglobin was 9 g/dl. Esophagogastroduodenoscopy showed multiple odd-looking lesions in the mid-gastric body measuring 1.5 cm with heaped up edges and central ulceration (Fig. 1). Similar lesions were noted throughout the duodenum. One of the lesions in proximal D2 had a large central ulceration and a prominent vessel in the base. Biopsy of the gastric lesion showed poorly differentiated large cell carcinoma (Fig. 2). Helicobacter pylori was not detected. Computed Tomography/Positron Emission Tomography scan showed avid uptake in the left hilum, adrenal glands and numerous osseous and soft tissue lesions. The overall condition was consistent with lung cancer with metastasis to the upper gastrointestinal tract. A similar picture might be seen with gastrointestinal stromal tumours which Fig. 2.
occasionally have central ulceration. Given her poor condition, the patient chose hospice care. Haematogenous metastatic involvement of the stomach is rare. The most common primary tumours are malignant melanoma, breast carcinoma, and lung carcinoma [1]. Gastrointestinal bleeding from lung carcinoma metastasis is very rare. Gastric metastases usually are not detected during the life time of the patient. Haematogenous metastases are generally situated in the submucosa and often remain asymptomatic unless the mucosa becomes involved. The “volcano-like” appearance is characteristic. Reference
Fig. 1.
[1] Kadakia SC, Parker A, Canales L. Metastatic tumors to the upper gastrointestinal tract: endoscopic experience. American Journal of Gastroenterology 1992;87:1418–23.
∗ Corresponding author at: One Hospital Drive, DC043.00 Health Sciences Center, Columbia, MO 65212, USA. Tel.: +1 5738841606; fax: +1 5738845690. E-mail address: [email protected] (M. Esmadi). 1590-8658/$36.00 © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.dld.2013.10.019
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Upper gastrointestinal tract metastasis from lung cancer Mohammad Esmadi ∗ , Dina S. Ahmad, Yumei Fu, Hazem T. Hammad Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO, USA
A 62 year-old female with a history of smoking presented with abdominal pain, melena, and cough for one month. She was hypotensive and tachycardic. Her haemoglobin was 9 g/dl. Esophagogastroduodenoscopy showed multiple odd-looking lesions in the mid-gastric body measuring 1.5 cm with heaped up edges and central ulceration (Fig. 1). Similar lesions were noted throughout the duodenum. One of the lesions in proximal D2 had a large central ulceration and a prominent vessel in the base. Biopsy of the gastric lesion showed poorly differentiated large cell carcinoma (Fig. 2). Helicobacter pylori was not detected. Computed Tomography/Positron Emission Tomography scan showed avid uptake in the left hilum, adrenal glands and numerous osseous and soft tissue lesions. The overall condition was consistent with lung cancer with metastasis to the upper gastrointestinal tract. A similar picture might be seen with gastrointestinal stromal tumours which Fig. 2.
occasionally have central ulceration. Given her poor condition, the patient chose hospice care. Haematogenous metastatic involvement of the stomach is rare. The most common primary tumours are malignant melanoma, breast carcinoma, and lung carcinoma [1]. Gastrointestinal bleeding from lung carcinoma metastasis is very rare. Gastric metastases usually are not detected during the life time of the patient. Haematogenous metastases are generally situated in the submucosa and often remain asymptomatic unless the mucosa becomes involved. The “volcano-like” appearance is characteristic. Reference
Fig. 1.
[1] Kadakia SC, Parker A, Canales L. Metastatic tumors to the upper gastrointestinal tract: endoscopic experience. American Journal of Gastroenterology 1992;87:1418–23.
∗ Corresponding author at: One Hospital Drive, DC043.00 Health Sciences Center, Columbia, MO 65212, USA. Tel.: +1 5738841606; fax: +1 5738845690. E-mail address: [email protected] (M. Esmadi). 1590-8658/$36.00 © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.dld.2013.10.019
