An ALK-positive lung adenocarcinoma with gastric and skin metastasis: a case report and literature review

Abstract

Primary lung cancer with gastric metastasis is rare to see in the world, little is known about its characteristics. Here, we describe the first case of primary lung adenocarcinoma with gastric and skin metastases along with a review of literature to help clinical decision making. A 49-year-old woman admitted to our department for abdominal distension. The immunohistochemistry staining for the biopsy in the gastric fundus, back and lung showed positive for CK5/6, TTF-1, Napsin A and CK7, but negative for CK20, which strongly indicated all of them were homologous and might originate from lung adenocarcinoma.Chromosome mutation analysis presented an EML4-ALK fusion gene. Brain metastases occurred after 6 months with crizotinib treatment. More than two months later, intracranial lesions became more and larger as she persisted in taking crizotinib plus whole-brain radiotherapy (WBRT). Hence, alectinib was performed due to the continuous growth of brain lesions. When reexamined three months later, the craniocerebral lesions were significantly reduced and all tumor markers were up to normal level. This review comprised 42 published case reports in total. Generally, the average morbidity age was 62 years old, and male with smoking history were more prone to it. It could be found that squamous cell carcinoma (17/38) accounts for a high proportion of gastrointestinal metastases pathology, most of which were poorly differentiated. Surgical excision of the lesions was supposed to improve long-term prognosis, mitigate associated complications, decrease patients' pain, and enhance the quality of life. Gastric metastasis of lung cancer is apt to metastasize to the brain, and the prognosis is inferior. Crizotinib with preventive WBRT may be the optimal choice for NSCLC patients harboring ALK mutation in the initial treatment of gastric metastasis. However, If the lesion in the brain keep on going, timely replacement to alectinib is an appropriate choice.

Endoscopic manifestations and treatment outcomes of asymptomatic gastric metastases from primary lung adenocarcinoma: Report of two cases

“…The two cases reported in the present study are gastric metastasis from lung adenocarcinoma without any related symptoms. They presented as diminutive nodules or erosion under conventional white-light endoscopy, which is different from the common endoscopic appearance of gastric metastasis ( 6 , 10 ). In addition, most of the literature only describes the manifestations of gastric metastasis from lung cancer under white-light endoscopy ( 6 , 14 ).…”

“…In the two cases presented in the current study, EGD revealed that the gastric metastatic lesions had regressed to scars after systemic anticancer therapy. The systemic treatment outcomes of primary lung cancer with gastric metastasis have been previously reported, but the focus was on the therapeutic effect on the primary tumor rather than the gastric metastatic lesions ( 10 ). To the best of our knowledge, only one previous study reported the systemic treatment outcomes of gastric metastasis from lung cancer; the gastric metastasis exhibited complete regression after 3 months of oral treatment with Osimertinib ( 12 ).…”

“…In most cases, gastric metastases are discovered at an advanced stage when patients experience symptoms, such as abdominal pain, anemia or vomiting, due to perforation, bleeding or obstruction caused by the metastatic mass ( 6 , 7 ), which usually predict poor prognosis; the average time between discovery of gastrointestinal metastasis and death ranges from 96.5 to 130.3 days, as reported in certain case series ( 8 , 9 ). Asymptomatic and diminutive gastric metastases are rarely found in the clinic and the manifestations of gastric metastases from lung cancer under chromoendoscopy and magnifying endoscopy have not been reported in the literature, to the best of our knowledge; furthermore, although there are certain reports regarding the systemic treatment outcome of primary lung cancer with gastric metastasis, which mainly focus on the therapeutic effect of primary tumor treatment ( 10 , 11 ), the effect of systemic treatment on gastric metastatic lesions is not well documented. In the two cases presented in the current study, the gastric metastases from lung adenocarcinoma manifested as diminutive nodules or erosion endoscopically and had certain common characteristics under magnifying endoscopy with blue laser imaging (BLI-ME).…”

Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis

“…A total of 114 cases were recruited in the present review (113 from the literature plus our case, Table S1) (2,. As shown in Table 1, the median age was 65 years (range, 59-71 years).…”

“…The most common sites of extrapulmonary metastases are the liver, bone, brain, and adrenal glands (1). In very rare circumstances, lung cancer may metastasize to the stomach, the incidence of which has been reported to range from 0.19% to 5.1%, with a higher rate reaching 2%-14% in autopsy studies (2). Because of advances in the diagnosis and treatment of cancer, patients' survival has gradually prolonged, making the encounter with gastric metastasis more frequent.…”