Case Report
Lung Cancer: A Frequent Tumor With a Rare Synchronous Metastasis
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array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "Deposition and Clinical Impact of Inhaled Particles in the Lung" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "377" "paginaFinal" => "382" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1326 "Ancho" => 1675 "Tamanyo" => 136853 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mechanisms of deposition of particles in the lung.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pere Casan Clarà, Francisco Rodríguez Jerez, José Belda Ramírez, Cristina Martínez González" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Pere Casan" "apellidos" => "Clarà" ] 1 => array:2 [ "nombre" => "Francisco Rodríguez" "apellidos" => "Jerez" ] 2 => array:2 [ "nombre" => "José Belda" "apellidos" => "Ramírez" ] 3 => array:2 [ "nombre" => "Cristina Martínez" "apellidos" => "González" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623000273?idApp=UINPBA00003Z" "url" => "/03002896/0000005900000006/v2_202308080837/S0300289623000273/v2_202308080837/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Lung Cancer: A Frequent Tumor With a Rare Synchronous Metastasis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "383" "paginaFinal" => "384" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Castro Barbosa, Augusto Silva, Alexandra Pignatelli" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ana" "apellidos" => "Castro Barbosa" "email" => array:1 [ 0 => "anabarbosa.med@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Augusto" "apellidos" => "Silva" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 2 => array:3 [ "nombre" => "Alexandra" "apellidos" => "Pignatelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Medicina Interna, Centro Hospitalar Universitário Lisboa Norte, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Reumatologia e Doenças Ósseas e Metabólicas, Centro Hospitalar Universitário Lisboa Norte, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Anatomia Patológica, Centro Hospitalar Universitário Lisboa Norte, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1274 "Ancho" => 2007 "Tamanyo" => 316376 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Thoracic scan showing a pulmonary mass in the right upper lobe, measuring 90<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>87<span class="elsevierStyleHsp" style=""></span>mm. (B) Abdominal and pelvic CT scan showing a mass on the left flank with 103<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>83<span class="elsevierStyleHsp" style=""></span>mm. (C and D) The tumor cells express both TTF-1 and cytokeratin 7, which is compatible with pulmonary origin. (E) H&E staining: poorly differentiated adenocarcinoma.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lung cancer is one of the most common cancers and a leading cause of cancer associated death.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> About 50% of all lung cancers have distant metastasis at the diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> The gastrointestinal system is rarely involved.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,4</span></a> Symptomatic colonic metastasis is extremely rare, with an estimated incidence of 0.2–0.5%, and usually only clinically identified in advanced stages.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Likewise, metastases to the oral cavity are very uncommon, however they can be the first manifestation of a primary tumor.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">An 82-year-old woman presented to the emergency department with a 15-day history of diarrhea (no blood or mucus), intermittent abdominal pain and asthenia. No fever associated and no history of cancer or smoking habits. Her medical history included hypertension, dyslipidemia, renal lithiasis and total hysterectomy. She had been followed up in stomatology in the previous month, for the recent appearance of an exophytic lesion in the lower right gingival. On emergency admission, physical examination revealed a palpable, bulky abdominal mass on the left flank and umbilical region. Blood tests revealed anemia (9.1<span class="elsevierStyleHsp" style=""></span>g/dL), leukocytosis (20.55<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L), neutrophilia (17.3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L) and high C reactive protein (27<span class="elsevierStyleHsp" style=""></span>mg/dL). Thoracic and abdominal computed tomography scan showed two masses, one in the pulmonary right upper lobe, measuring 90<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>87<span class="elsevierStyleHsp" style=""></span>mm, and the second on the left flank with 103<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>83<span class="elsevierStyleHsp" style=""></span>mm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). Abdominal, lung and gingival lesions histopathology revealed poorly differentiated pulmonary adenocarcinoma. Immunohistochemistry was negative for CDX2, cytokeratin20, GATA-3 and reactive for CK7 and TTF-1 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C–E). These findings support that the metastatic lesions were from a primary lung carcinoma. Unfortunately, the patient died two months after the diagnosis due to an infectious complication.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The case we report is an exceptionally rare presentation of synchronous colonic and gum metastasis of primary lung adenocarcinoma. The exact incidence of lung adenocarcinoma metastases to the colon is unknown because most of them are from squamous and large cell carcinomas.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Metastasis in the oral mucosa are also very rare, with a poor prognosis. These metastasis may be the initial manifestation of neoplasia in about a quarter of cases, although they are frequently confused with benign lesions of the oral soft tissues.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This report emphasizes that exophytic gingival lesions of recent appearance, despite patterns of benignity, should be actively examined and a biopsy should be carried out for definitive diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no funding to declare.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Competing Interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no competing interests to declare related to this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Competing Interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Both authors contributed equally to this work.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1274 "Ancho" => 2007 "Tamanyo" => 316376 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Thoracic scan showing a pulmonary mass in the right upper lobe, measuring 90<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>87<span class="elsevierStyleHsp" style=""></span>mm. (B) Abdominal and pelvic CT scan showing a mass on the left flank with 103<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>83<span class="elsevierStyleHsp" style=""></span>mm. (C and D) The tumor cells express both TTF-1 and cytokeratin 7, which is compatible with pulmonary origin. (E) H&E staining: poorly differentiated adenocarcinoma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colonic metastasis from primary lung adenocarcinoma: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Thomas" 1 => "Z. Mirza" 2 => "D. Coppola" 3 => "M. Friedman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "AME Med J" "fecha" => "2017" "volumen" => "2" "paginaInicial" => "12" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary lung cancer presenting with metastasis to the colon: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Sakai" 1 => "H. Egi" 2 => "T. Hinoi" 3 => "M. Tokunaga" 4 => "Y. Kawaguchi" 5 => "M. Shinomura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "World J Surg Oncol" "fecha" => "2012" "volumen" => "10" "paginaInicial" => "127" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastrointestinal metastasis from primary lung cancer. Case series and systematic literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Balla" 1 => "J.D. Subiela" 2 => "J.S. Bollo" 3 => "C. Martínez" 4 => "C.R. Luppi" 5 => "P. Herná Ndez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2017.12.011" "Revista" => array:6 [ "tituloSerie" => "Cir Esp (Engl Ed)" "fecha" => "2018" "volumen" => "96" "paginaInicial" => "184" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29567360" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastric and colonic metastases from primary lung adenocarcinoma: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.M. Huang" 1 => "T.Y. Hsieh" 2 => "J.R. Chen" 3 => "H.P. Chien" 4 => "P.H. Chang" 5 => "C.H. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3892/ol.2012.778" "Revista" => array:6 [ "tituloSerie" => "Oncol Lett" "fecha" => "2012" "volumen" => "4" "paginaInicial" => "517" "paginaFinal" => "520" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22970049" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastasis of lung adenocarcinoma to the gingiva: a rare case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Rajini Kanth" 1 => "A. Ravi Prakash" 2 => "Y. Raghavendra Reddy" 3 => "J. Sonia Bai" 4 => "M. Ravindra Babu" 5 => "R.M. Kanth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Iran J Med Sci" "fecha" => "2015" "volumen" => "40" "paginaInicial" => "287" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25999632" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005900000006/v2_202308080837/S0300289623000248/v2_202308080837/en/main.assets" "Apartado" => array:4 [ "identificador" => "93562" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005900000006/v2_202308080837/S0300289623000248/v2_202308080837/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623000248?idApp=UINPBA00003Z" ]
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