Louisiana State University Health Sciences Center New Orleans, LA
Scott R. Piechocki, MD, MS1, Lara Boudreaux, MD2, Jason Stibbe, MD, MS3 1Louisiana State University Health Sciences Center, New Orleans, LA; 2LSU Health Sciences Center, New Orleans, LA; 3LSU Health, New Orleans, LA
Introduction: Metastasis of primary non-small cell lung cancer to the small bowel is uncommon. Patients can present with obstruction, perforation, peritonitis, or gastrointestinal bleeding. The duodenum remains the least-commonly reported affected site for metastasis to the small bowel. Here, we present a patient with melena attributed to metastasis of non-small cell lung cancer to the duodenum.
Case Description/Methods: The patient is a 71 year-old male with a past medical history of stage IV non-small cell lung cancer and hypertension who presented with dyspnea on exertion for 1 day and recent intermittent episodes of dark stools. The patient’s labs upon arrival were significant for a hemoglobin of 6.7 g/dL, which responded appropriately to transfusion of 1 unit of packed red blood cells. He was treated with a proton pump inhibitor twice daily while hospitalized and underwent subsequent EGD. Endoscopy was remarkable for a large mass in the first part of the duodenum (image A) and a small ulcerated mass in the second part of the duodenum (image B) which were not actively bleeding. Biopsy histology was consistent with metastatic carcinoma of non-small cell lung primary. The patient’s hemoglobin remained stable and he was discharged with close followup to initiate outpatient chemotherapy.
Discussion: Involvement of the small bowel in metastasis of non-small cell lung cancer is rare. The most commonly involved sites include the liver, adrenal glands, bone, and brain. In one case series involving 1544 patients with primary lung cancer, only 7 were found to have metastasis to the small intestine. The decreased frequency of discovered duodenal metastasis from non-small cell lung cancer is likely influenced by the advanced stage of primary cancer and the subtle presentation consisting of nonspecific symptoms such as nausea, abdominal pain, and occult or infrequent bleeding. Diagnosis is typically made through recognition of clinical symptoms, imaging including CT scan, and endoscopy. The risk of gastrointestinal bleeding secondary to duodenal metastasis can be reduced by inducing atrophy of the lesions with chemotherapy. Unfortunately, patients with metastasis of primary lung cancer to the small bowel have a poor outcome. Physicians should remain aware of the possibility of distant metastatic lesions as a cause of gastrointestinal bleeding.
Figure: Image A: Large mass in the first part of the duodenum. Image B: Small ulcerated mass in the second part of the duodenum.
Disclosures:
Scott Piechocki indicated no relevant financial relationships.
Lara Boudreaux indicated no relevant financial relationships.
Jason Stibbe indicated no relevant financial relationships.
Scott R. Piechocki, MD, MS1, Lara Boudreaux, MD2, Jason Stibbe, MD, MS3. P3524 - The Duodenum: An Uncommon Site of Lung Cancer, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
