Pulmonary enteric adenocarcinoma with pancreatic metastasis: A case report

Abstract

Abstract. Pulmonary enteric adenocarcinoma is a markedly rare pathological type of lung adenocarcinoma. As the pancreas is a relatively uncommon site for metastasis, the present case is even more unusual. A 62-year-old male was admitted to hospital following the identification of masses in the left chest wall, right abdominal wall and right upper limb, but with no respiratory symptoms. Computed tomography (CT) of the chest revealed a lump in the lung and a mass in the left chest wall, and 18 F-fluorodeoxyglucose ( 18 F-FDG) uptake by the lumps was increased. An enhanced abdominal CT revealed a hypodense and homogeneous mass on the head of the pancreas, which was slightly enhanced compared with normal pancreatic tissue. In addition, the 18 F-FDG uptake of the lesion was increased and the standardized uptake value (SUV) delayed was not evidently decreased compared with SUVearly. A number of other abnormal metabolic lesions were also identified using positron emission tomography/CT, whereas no abnormal 18 F-FDG uptake was identified in the gastrointestinal organ. Furthermore, rectocolonoscopy was performed to exclude diagnosis of metastatic colorectal adenocarcinoma. The hematoxylin-and eosin-stained smears of the masses in the right lung and left chest demonstrated an enteric pattern, which shared morphological and immunohistochemical (IHC) features with those of colorectal adenocarcinoma. The IHC detection revealed that the lesions in the right lung were positive for cytokeratin 7 (CK7), and negative for CK20 and thyroid transcription factor 1 (TTF-1), and the expression of caudal type homeobox 2 (CDX2) was weakly positive; the masses in the left chest wall were positive for CK7, negative for TTF-1, and CK20 and CDX2 were weakly expressed.

Pulmonary enteric adenocarcinoma: a literature review

“…Almost 51.2% (22/43) of the patients in these literatures went to the doctor for coughing and 20.9% (9/43) for chest or back pain. The probability of hemoptysis, fever, and cystic mass were relatively lower, at about 16.3% (7/43), 11.6% (5/43), and 11.6% (5/43) respectively (1,6,8,(10)(11)(12)(13)(14)(15)(16)(17)(19)(20)(21). Only a small number of patients from abnormal lesions detected on health examinations, at about 4.7% (2/43).…”

“…The following pathologic criterion for PEAC was also set out: if the intestinal differentiation component in lung adenocarcinoma exceeds 50%, the tumor can be classified as PEAC (2). Despite PEAC being subsequently proposed in the 2015 World Health Organization classification, due to the rarity of the disease, systematic guidance or recommendations regarding its diagnosis, treatment, and of respiratory symptoms such as coughing, expectoration, chest pain, dizziness, hemoptysis, fever, bronchitis, and other related discomfort (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Almost 51.2% (22/43) of the patients in these literatures went to the doctor for coughing and 20.9% (9/43) for chest or back pain.…”

Cutaneous metastasis as a primary presentation of a pulmonary enteric adenocarcinoma

“…After comparing cytological features of the primary lung neoplasm and subcutaneous metastasis, these two pathological tissues showed similar morphological and IHC characteristics. 8 With the advent of NGS technologies in recent years, new perspectives have emerged in delineating new molecular profiles of PEACs, but at present only a limited number of studies have applied these methodologies. 4 Once any gastrointestinal lesion was excluded in our case at the staging diagnostic examination, the identification of the same IHC features and pathogenic gene variants confirmed the common origin of the cutaneous lesion with the primary pulmonary nodule.…”

“…After comparing cytological features of the primary lung neoplasm and subcutaneous metastasis, these two pathological tissues showed similar morphological and IHC characteristics. 8…”

Pulmonary enteric adenocarcinoma: an overview

“…Most studies were single-case reports or small patient series (Refs 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 16, 17, 21, 22, 29, 30, 31, 32, 34, 35, 36, 37, 38, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61) whereas sporadic cases were also described within larger studies on lung cancer, from which it was not always possible to retrieve demographic and clinical information (Refs 62, 63, 64, 65).…”