Pulmonary enteric adenocarcinoma with pancreatic metastasis: A case report

Sun,Wen‑Wen; Xu,Zhi‑Hong; Wang,Chao-Fu; Wu,Fang; Cao,Jiu‑Mei; Cui,Pei‑Jing; Huang,Wei; Jin,Xiao‑Long; Li,Biao; Chen,Ke‑Min; Gao,Bei‑Li; Hu,Jia‑An

doi:10.3892/ol.2017.6060

Pulmonary enteric adenocarcinoma with pancreatic metastasis: A case report

Authors:
- Wen‑Wen Sun
- Zhi‑Hong Xu
- Chao-Fu Wang
- Fang Wu
- Jiu‑Mei Cao
- Pei‑Jing Cui
- Wei Huang
- Xiao‑Long Jin
- Biao Li
- Ke‑Min Chen
- Bei‑Li Gao
- Jia‑An Hu
View Affiliations

Affiliations: Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China, Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China, Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China, Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China, Department of Respiration, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
Published online on: April 20, 2017 https://doi.org/10.3892/ol.2017.6060
Pages: 4651-4656

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

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 18F‑fluorodeoxyglucose (18F‑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 18F‑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 18F‑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.

View Figures

View References

1	Tsao MS and Fraser RS: Primary pulmonary adenocarcinoma with enteric differentiation. Cancer. 68:1754–1757. 1991. View Article : Google Scholar : PubMed/NCBI
2	Yousem SA: Pulmonary intestinal-type adenocarcinoma does not show enteric differentiation by immunohistochemical study. Mod Pathol. 18:816–821. 2005. View Article : Google Scholar : PubMed/NCBI
3	Inamura K, Satoh Y, Okumura S, Nakagawa K, Tsuchiya E, Fukayama M and Ishikawa Y: Pulmonary adenocarcinomas with enteric differentiation: Histologic and immunohistochemical characteristics compared with metastatic colorectal cancers and usual pulmonary adenocarcinomas. Am J Surg Pathol. 29:660–665. 2005. View Article : Google Scholar : PubMed/NCBI
4	Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Powell CA, Beer D, Riely G, Garg K, et al: International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: International multidisciplinary classification of lung adenocarcinoma: Executive summary. Proc Am Thorac Soc. 8:pp. 381–385. 2011; View Article : Google Scholar : PubMed/NCBI
5	Maeda R, Isowa N, Onuma H and Miura H: Pulmonary intestinal-type adenocarcinoma. Interact Cardiovasc Thorac Surg. 7:349–351. 2008. View Article : Google Scholar : PubMed/NCBI
6	Li HC, Schmidt L, Greenson JK, Chang AC and Myers JL: Primary pulmonary adenocarcinoma with intestinal differentiation mimicking metastatic colorectal carcinoma: Case report and review of literature. Am J Clin Pathol. 131:129–133. 2009. View Article : Google Scholar : PubMed/NCBI
7	Hatanaka K, Tsuta K, Watanabe K, Sugino K and Uekusa T: Primary pulmonary adenocarcinoma with enteric differentiation resembling metastatic colorectal carcinoma: A report of the second case negative for cytokeratin 7. Pathol Res Pract. 207:188–191. 2011. View Article : Google Scholar : PubMed/NCBI
8	Qureshi A and Furrukh M: Enteric adenocarcinoma lung: A rare presentation in an Omani woman. BMJ Case Rep. 2013:bcr2012007667. 2013. View Article : Google Scholar
9	Lin D, Zhao Y, Li H and Xing X: Pulmonary enteric adenocarcinoma with villin brush border immunoreactivity: A case report and literature review. J Thorac Dis. 5:E17–E20. 2013.PubMed/NCBI
10	Stojsic J, Kontic M, Subotic D, Popovic M, Tomasevic D and Lukic J: Intestinal type of lung adenocarcinoma in younger adults. Case Rep Pulmonol. 2014:2821962014.PubMed/NCBI
11	Wang CX, Liu B, Wang YF, Zhang RS, Yu B, Lu ZF, Shi QL and Zhou XJ: Pulmonary enteric adenocarcinoma: A study of the clinicopathologic and molecular status of nine cases. Int J Clin Exp Pathol. 7:1266–1274. 2014.PubMed/NCBI
12	László T, Lacza A, Tóth D, Molnár TF and Kálmán E: Pulmonary enteric adenocarcinoma indistinguishable morphologically and immunohistologically from metastatic colorectal carcinoma. Histopathology. 65:283–287. 2014. View Article : Google Scholar : PubMed/NCBI
13	Handa Y, Kai Y, Ikeda T, Mukaida H, Egawa H and Kaneko M: Pulmonary enteric adenocarcinoma. Gen Thorac Cardiovasc Surg. 64:749–751. 2015. View Article : Google Scholar : PubMed/NCBI
14	Metro G, Valtorta E, Siggillino A, Lauricella C, Cenci M, Ludovini V, Minenza E, Prosperi E, Ricciuti B, Rebonato A, et al: Enteric-type adenocarcinoma of the lung harbouring a novel KRAS Q22K mutation with concomitant KRAS polysomy: A case report. Ecancermedicalscience. 9:5592015. View Article : Google Scholar : PubMed/NCBI
15	Wei QZ, Liu JH, Zhang ZX, Yang Q and Zhao T: Expression and significance of TTF-1, CK7, CK5/6, P63 and CD20 in mucin producing lung cancer. Clin J Diffic and Compl Cas. 9:822–824. 2010.(In Chinese).
16	Wang CX, Xu Y, Liu B, Zhang J, Yu B, Shi SS and Zhou XJ: Clinicopathologic features and differential diagnosis of pulmonary intestinal-type adenocarcinoma. J Clin Exp Pathol. 29:1101–1104. 2013.(In Chinese).
17	Geles A, Gruber-Moesenbacher U, Quehenberger F, Manzl C, Al Effah M, Grygar E, Juettner-Smolle F and Popper HH: Pulmonary mucinous adenocarcinomas: Architectural patterns in correlation with genetic changes, prognosis and survival. Virchows Arch. 467:675–686. 2015. View Article : Google Scholar : PubMed/NCBI
18	Suzuki M, Yazawa T, Ota S, Morimoto J, Yoshino I, Yamanaka S, Inayama Y, Kawabata Y, Shimizu Y, Komatsu M, et al: High-grade fetal adenocarcinoma of the lung is a tumour with a fetal phenotype that shows diverse differentiation, including high-grade neuroendocrine carcinoma: A clinicopathological, immunohistochemical and mutational study of 20 cases. Histopathology. 67:806–816. 2015. View Article : Google Scholar : PubMed/NCBI
19	Smith AL, Odronic SI, Springer BS and Reynolds JP: Solid tumor metastases to the pancreas diagnosed by FNA: A single-institution experience and review of the literature. Cancer Cytopathol. 123:347–355. 2015. View Article : Google Scholar : PubMed/NCBI
20	Shi HY, Zhao XS and Miao F: Metastases to the pancreas: Computed tomography imaging spectrum and clinical features: A retrospective study of 18 patients with 36 metastases. Medicine (Baltimore). 94:e9132015. View Article : Google Scholar : PubMed/NCBI
21	Sweeney AD, Fisher WE, Wu MF, Hilsenbeck SG and Brunicardi FC: Value of pancreatic resection for cancer metastatic to the pancreas. J Surg Res. 160:268–276. 2010. View Article : Google Scholar : PubMed/NCBI
22	Montezuma D, Azevedo R, Lopes P, Vieira R, Cunha AL and Henrique R: A panel of four immunohistochemical markers (CK7, CK20, TTF-1 and p63) allows accurate diagnosis of primary and metastatic lung carcinoma on biopsy specimens. Virchows Arch. 463:749–754. 2013. View Article : Google Scholar : PubMed/NCBI
23	Travis WD and Rekhtman N: Pathological diagnosis and classification of lung cancer in small biopsies and cytology: Strategic management of tissue for molecular testing. Semin Respir Crit Care Med. 32:22–31. 2011. View Article : Google Scholar : PubMed/NCBI
24	Ballarin R, Spaggiari M, Cautero N, de Ruvo N, Montalti R, Longo C, Pecchi A, Giacobazzi P, de Marco G, D'Amico G, et al: Pancreatic metastases from renal cell carcinoma: The state of the art. World J Gastroenterol. 17:4747–4756. 2011. View Article : Google Scholar : PubMed/NCBI
25	Karakan T, Cengiz M, İbiş M, Akyürek N and Ünal S: Pancreatic metastasis in a case of small cell lung carcinoma diagnosed by EUS. Turk J Gastroenterol. 26:53–55. 2015. View Article : Google Scholar : PubMed/NCBI
26	Tan CH, Tamm EP, Marcal L, Balachandran A, Charnsangavej C, Vikram R and Bhosale P: Imaging features of hematogenous metastases to the pancreas: Pictorial essay. Cancer Imaging. 11:9–15. 2011. View Article : Google Scholar : PubMed/NCBI
27	Wang XY, Yang F, Jin C and Fu DL: Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer. World J Gastroenterol. 20:15580–15589. 2014. View Article : Google Scholar : PubMed/NCBI
28	Nishiyama Y, Yamamoto Y, Monden T, Sasakawa Y, Tsutsui K, Wakabayashi H and Ohkawa M: Evaluation of delayed additional FDG PET imaging in patients with pancreatic tumour. Nucl Med Commun. 26:895–901. 2005. View Article : Google Scholar : PubMed/NCBI
29	Kato K, Nihashi T, Ikeda M, Abe S, Iwano S, Itoh S, Shimamoto K and Naganawa S: Limited efficacy of (18)F-FDG PET/CT for differentiation between metastasis-free pancreatic cancer and mass-forming pancreatitis. Clin Nucl Med. 38:417–421. 2013. View Article : Google Scholar : PubMed/NCBI