Rectal metastasis in Lung cancer: A case report and review of the literature

Gastrointestinal metastasis in lung cancer is not commonly encountered clinically, of which rectal involvement is a sporadic event. There were few reports about rectal metastasis in lung cancer. All of them had a dismal prognosis. We report a case of synchronous rectal metastasis in a lung cancer patient with a different clinical scenario, treatment, and prognosis. The patient presented with infrequent hematochezia due to a rectal mass confirmed as adenocarcinoma on core biopsy. Computer tomography showed many nodules in both lungs, which raised the initial diagnosis of pulmonary metastasis in rectal cancer. However, we decided to perform immunohistochemistry on the rectal biopsy specimen, which, surprisingly, revealed the site of origin was from the lung. Subsequently, next gene sequencing was performed and detected an exon 19 deletion on the EGFR gene. Though he had infrequent hematochezia, we decided to treat him with Erlotinib (a first-generation TKI) and closely monitored the rectal symptoms. Six months later, he achieved a complete response of both lung and rectal lesions. At present, he has been progression-free for 14 months. Thus, physicians should always be aware of this differential diagnosis in synchronous tumors and carefully consider the optimal treatment to start.

Rectal metastasis from bladder urothelial carcinoma: a case report

Background Urothelial carcinoma arises from transitional cells in the urothelial tract. In advanced cases, it can metastasize locally to surrounding organs or distally to organs such as the lungs, bones, or liver. Here we describe a case of rectal metastasis from urothelial carcinoma treated with multiple sessions of transurethral resection of bladder tumor (TURBT). Case presentation A 72-year-old woman presented to our department with abdominal bloating andobstructed defecation. She had undergone two sessions of TURBT for early urothelial carcinoma in another hospital at 64 and 65 months ago, respectively. Cystoscopy at 3 months after the second TURBT session had indicated disease recurrence, and thus, she had been referred to our hospital for further examination, followed by TURBT for the third time at 59 months ago and for the fourth time at 48 months ago; thereafter, she had been followed up with cystoscopy every 6 months without any recurrence. However, she returned to our hospital, complaining of difficult defecation. Subsequent colonoscopy demonstrated an obstructive tumor in the rectum, which was pathologically diagnosed as metastatic urothelial carcinoma of the bladder. Laparoscopic examination revealed two small areas of peritoneal dissemination in the pelvis. A sigmoid colostomy was performed without rectal tumor resection. She has been receiving chemotherapy and is still alive 10 months after surgery. Conclusions Rectal metastasis is a rare site of metastasis for urothelial carcinomas. It is important to consider the possibility of annular rectal constriction caused by infiltrating or metastasizing urothelial carcinoma when managing patients with urothelial carcinoma and with difficult defecation.

Infiltrating Ductal Breast Carcinoma Metastasized to the Rectum: A Case Report and a Review of the Literature

BACKGROUND:Gastrointestinal (GI) metastasis in breast cancer (BC) is uncommon, although in the rare cases when it occurs, infiltrating lobular carcinoma is the most commonly reported pathological subtype. Nonetheless, gastrointestinal metastasis from infiltrating ductal breast carcinoma is extremely rare and usually occurs several years after the appearance of the primary tumor. The present study was, to the best of our knowledge, the first one to present a case of distal rectum metastasis originating from infiltrating ductal breast carcinoma. CASE PRESENTATION:The present report discusses the case of a Chinese female patient aged 37 years. The patient presented with diarrhea along with bloody stools and anal bearing-down pain. Earlier in 2015, she had undergone axillary lymph node dissection (LND) and right modified radical mastectomy in another hospital to treat the infiltrating ductal breast carcinoma pT1N1M0. The presented symptoms were investigated by performing colonoscopy, which indicated lower rectal swelling at 3 cm on the top of the anal verge. Further investigation with positron emission tomography-computed tomography (PET-CT) revealed an uptake of fluorodeoxyglucose (FDG) within the distal rectum as well as in the left acetabulum. The samples from laparoscopic exploration were biopsied, which revealed metastases of breast cancer. Therefore, the patient was intraoperatively diagnosed with the rectal metastasis of BC and was treated with laparoscopic radical abdominoperineal resection. Furthermore, the immunohistochemical analysis of the tumor confirmed that the patient had the rectal metastasis of infiltrating ductal BC. CONCLUSION:Rectal metastasis should be considered when breast cancer patients present with a complaint of changed bowel habits, even for those with a history of ductal breast cancer.

Metachronous rectal metastasis from pulmonary adenocarcinoma after 11 years of chemo-, immuno-, and radiotherapy for recurrent lesions: a case report

Background Rectal metastasis from pulmonary adenocarcinoma is rare, and it has been regarded as an end-stage phenomenon. Recently, however, advances in lung cancer treatment have improved the chance of long-term survival of patients with unresectable distant metastases. We describe the occurrence and management of metastatic spread of a pulmonary carcinoma to the rectum. Case presentation The patient was a 79-year-old woman who had undergone thoracoscopic left lobectomy for pulmonary adenocarcinoma and then, over the next 11 years, various drugs (carboplatin + paclitaxel (as adjuvant therapy), gefitinib, gemcitabine + vinorelbine, S1 (an oral 5-fluorouracil-based drug), carboplatin + pemetrexed + bevacizumab, erlotinib, nivolumab, afatinib, and carboplatin+ S1) were administered, especially for hilar and mediastinal lymph node recurrences. During the eleventh postoperative year, left and right iliac bone metastases were detected, and radiation therapy was undertaken for local control of these lesions. When 18F-fluorodeoxyglucose positron emission tomography was performed for evaluation of the disease, tracer accumulation in the upper rectum was seen. Colonoscopic examination of the rectum revealed an intramural mass with central ulceration, and the mass was diagnosed histologically as an adenocarcinoma. The bone metastases appeared to be controlled, and the patient’s performance status was good, but she had suffered constipation for about a year and desired treatment. Thus, laparoscopic low anterior resection was performed. Histopathologic analysis revealed a moderately differentiated adenocarcinoma existing mainly between the submucosa and serosa, and immunohistochemical analysis showed the tumor to be positive for cytokeratin (CK) 7, negative for CK20, positive for thyroid transcription factor-1, and negative for special AT-rich sequence-binding protein 2 and caudal type homeobox 2, confirming the diagnosis of rectal metastasis from the primary pulmonary adenocarcinoma. The patient recovered well without any change in her functional status. Systemic chemotherapy was resumed, and she continues to do well, now 6 months after surgery. Conclusions Surgery may be a good option for the management of an isolated rectal metastasis from pulmonary cancer in patients whose functional status is good.