Journal of Postgraduate Medicine
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CASE REPORT
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Year : 2002  |  Volume : 48  |  Issue : 3  |  Page : 199-200  

Colonic metastasis from bronchogenic carcinoma presenting as pancolitis.

AK John, A Kotru, HJ Pearson 
 Department of Surgery, Diana, Princess of Wales Hospital, Grimsby DN33 2BA, UK.

Correspondence Address:
A K John
Department of Surgery, Diana, Princess of Wales Hospital, Grimsby DN33 2BA, UK.

Abstract

The colonic metastases from bronchogenic carcinoma are rare. We present a 73-year-old man presented with features suggestive of pan colitis after metastasis from undifferentiated large cell carcinoma of the lung. The plain radiograph and computed tomography scan of the chest had revealed a mass lesion in the right lower lobe of lung. He had no evidence of significant lesions elsewhere. Considering the advanced stage and poor differentiation of the tumour, no active therapy was undertaken and he survived for three months.



How to cite this article:
John A K, Kotru A, Pearson H J. Colonic metastasis from bronchogenic carcinoma presenting as pancolitis. J Postgrad Med 2002;48:199-200


How to cite this URL:
John A K, Kotru A, Pearson H J. Colonic metastasis from bronchogenic carcinoma presenting as pancolitis. J Postgrad Med [serial online] 2002 [cited 2023 Jan 30 ];48:199-200
Available from: https://www.jpgmonline.com/text.asp?2002/48/3/199/106


Full Text

The bronchogenic carcinoma has been reported as a cause of metastases in the colon. They may present clinically or as a finding at autopsy. We present a case of synchronous extensive metastases in the colon presenting with features of pancolitis.


  ::   Case historyTop


A 73-years-old man presented to the colorectal clinic with a history of diarrhoea, bleeding per rectum and weight loss. He had no significant past medical illness. The clinical examination was unremarkable. A colonoscopy showed haemorrhagic inflammation, mucosal destruction, granulation tissue formation and multiple polypoidal lesions [Figure:1] in the entire length of colon suggesting pan colitis. Biopsies were taken from the colon at a distance of 70cm, 90cm, 100cm and 110cm. The plain radiograph and computed tomography (CT) scan of the chest showed a mass lesion in the right lower lobe of lung [Figure:2], which was biopsied bronchoscopically. He had no evidence of significant lesions elsewhere. The bronchial biopsy revealed an undifferentiated large cell carcinoma of the lung. The colonic biopsies were reported as metastases from this undifferentiated large cell carcinoma [Figure:3]. Considering the advanced stage and poor differentiation of the tumour, no active therapy was given. He died three months after the presentation.


  ::   DiscussionTop


Metastatic lesions in the large bowel are rare and can pose diagnostic and management difficulties. They can present as a primary tumour of the colon or with the features of a disseminated primary malignancy.[1],[2] The malignancies known to cause secondaries in the large bowel are stomach, breast, ovary, cervix, kidney, lung, bladder, prostate, and melanoma. The usual presentation is with multiple metastatic deposits, but can present as solitary lesion also.

In our case, the symptoms of diarrhoea, bleeding per rectum, and endoscopic appearance of pan colitis were initially suggestive of a diagnosis of an inflammatory bowel disease. The diagnosis of the unusual disease process was revealed by the biopsy and established after the consensus in multidisciplinary (Pathology, Radiology, Oncology and Surgery) meeting. We believe the appearance of pan colitis in this case could be from the extensive tumour involvement of colonic mucosa and excessive proliferative activity of a poorly differentiated malignancy.

The colonic metastases from lung cancer may present clinically or as a finding at autopsy.[3] Clinically they present with symptoms of colonic obstruction, lower gastrointestinal bleed (occult or massive), weight loss, anaemia, bowel perforation, or gastrointestinal fistula.[4],[5],[6],[7],[8] The usual presentation is after the diagnosis of the primary lesion, but can occur synchronously or before the diagnosis of the primary.[2],[4]

The lung cancer with intestinal metastasis has been reported to have poor prognosis with mean survival of only 4-8 weeks.[9] The treatment modalities depend on the nature of presentation and extent of the disease. The colonic lesions complicated by obstruction, bleeding, or perforation has to be treated before the assessment of the lung lesion.[2] Depending on the extent of the disease, the treatment options are a ‘curative resection’, palliative procedure (resection or stoma), or no active therapy.[10] The ‘curative resection’ (resection of the colonic and lung lesions), in selected patients, is reported to have survival advantage.[1],[10]

Bronchogenic carcinoma rarely causes synchronous or metachronous metastases in the colon. In those cases, the treatment options are a ‘curative resection’, palliative procedure, or no active therapy, depending on the extent and differentiation of the tumour. In selected cases, the ‘curative resection’ has survival advantage.

References

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3Toyama K, Sakaguchi T, Noto M, Okada N, Otaka H, Segi K. An autopsy case of squamous cell carcinoma of the lung presenting with small and large bowel metastasis. Gan No Rinsho 1984;30:975-9.
5Smith HJ, Vlasak MG. Metastasis to colon from bronchogenic carcinoma. Gastrointest Radiol 1978; 2:393- 6.
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7Bastos I, Gomes D, Gouveia H, de Freitas D. Colonic metastasis of a lung carcinoma with ileocolic fistula. J Clin Gastroenterol 1998;26:348.
8Wegener M, Borsch G, Reitemeyer E, Schafer K. Metastasis to colon from primary bronchogenic carcinoma presenting as occult gastrointestinal bleeding- report of a case. Gastroenterology 1998;26: 358-62.
9Polak M, Kuupryjanczyk J, Rell KW. A rare case of colonic perforation in a sole site of latent lung cancer metastasis. Pol Tyg Lek 1990;45:179-81.
10Kabwa L, Mattei JP, Noel JP. Intestinal metastases of broncho-pulmonary cancer. Apropos of a case. J Chir 1996;133:290-3.
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