BRAF V600Q-mutated lung adenocarcinoma with duodenal metastasis and extreme leukocytosis

Abstract

Driver mutations in patients with non-small cell lung cancer (NSCLC) can lead to distinct behaviors and patterns of metastasis. Mutations in the proto-oncogene B-raf (BRAF) occur in approximately 3% of NSCLC cases. In the literature, reports of patients with lung adenocarcinomas metastasizing to the duodenum are rare, and most of the only 21 cases reported were from before the advent of next-generation sequencing. We present here a case involving a 57-year-old female who had a lytic lesion in her lesser trochanter. Biopsy showed metastatic adenocarcinoma of lung origin. Chest X-ray showed a large left upper lobe mass. Next-generation sequencing analysis confirmed the presence of BRAF V600Q mutation. The patient presented with persistent anemia and melena. Esophagogastroduodenoscopy confirmed the presence of duodenal metastasis. She also had suspected paraneoplastic leukemoid reaction. To our knowledge, this is only the second well-documented case of gastrointestinal metastasis from BRAF-mutated lung cancer.

Duodenum metastatic adenocarcinoma of lung origin: A case report

“…Metastatic tumors of the duodenum are most frequently seen in the area around the duodenal bulb or in the periampullary region of the second portion of duodenum. However, previous research reports indicate that the locations of metastatic adenocarcinoma of lung origin in the duodenum were the second portion, 5,11 the third portion, 6 and the fourth portion of duodenum. 3,9,12 Besides, those patients were found in the opposite site of papilla of Vater, 4 in the duodenal bulb, 7 and bulging mucosa on the minor papilla of the duodenum abnormalities.…”

“…Duodenal metastasis is associated with dismal prognosis. Only a few cases have survived more than 12 months after surgical resection of duodenal metastases, [3][4][5][6][7] with the exception of one patient who survived 46 months. 8 Thus, metastases to multiple organs and other serious complications, treatment is only palliative.…”

“…Among small bowel metastasis, the jejunum is the most frequent site of involvement (50.9%), followed by the ileum (33.3%), and the duodenum (15.8%). 9 The vast majority of duodenum metastatic lung adenocarcinoma patients present with vague chief complaints such as weight loss, 3,4,9 melena, 3,5,7,9 anorexia, 3,4,6,9 epigastric pain or discomfort, 4,9,10 lethargy, 4,9 abdominal fullness, 6 altered bowel habit, 3 indigestion, 10 shortness of breath, 5 dyspnea on exertion, 3 weakness, 3,5 anemia, 7 fever, 6 cough, 3 blood stained sputum, 3 fatigue, 3 or no clinical symptoms. 11 Compared with previous case reports, the patient complaining of gastroesophageal reflux disease is rarely encountered in this report.…”

“…The periphery of the ulcer was elevated and covered with intact duodenal mucosa, and each lesion had an ulcer at the center and appeared as a submucosal mass with intact mucosa at its periphery. Endoscopic diagnosis of metastases to the duodenum from lung adenocarcinoma, abnormal conditions include ulcerative lesion with bleeding 5,12 or not, 9 tumor protruding into the lumen, 6 nodular protrusions of the mucosa, 3 a widely flat elevation with large central ulceration, 7,11 raised plaques, and erosion. 10 These characteristics are feature of metastatic tumors in the gastrointestinal tract.…”

“…Duodenal metastases are difficult to detect at early stages, due to ambiguous clinical symptoms and serious complications. [3][4][5][6][7] Herein we report our experience with a case of duodenum metastases from lung adenocarcinoma.…”