Synchronous Rectal and Brain Metastases From Non-small Cell Lung Cancer: Report of a Case.

SESSION TYPE: Cancer Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Lung cancer is the leading cause of cancer death in both male and female. Overall survival is around 15% at 5 years including all stages. The primary risk factor is smoking tobacco which accounts for 85% of all cancer-related deaths. Around 36% of patients are initially diagnosed as having stage IV disease, which includes most frequently liver (33%-40%), brain (15-43%), adrenal glands (18-38%) and bone (19-33%) metastases. Metastatic disease involving the gastrointestinal tract is uncommon being the small bowell the most common site. No cases of synchronous rectal and brain metastasis have been reported.CASE PRESENTATION: A 58 years old female was initially evaluated for presenting with left body hemiparesis. Brain MRI showed nodular cortical lesion in the temporoparietal area with cerebral edema. Surgical resection was then performed. CT of the chest revealed a lesion located in the right upper lobe which was biopsied. At the same time the patient developed hematochezia, sigmoidoscopy showed a lesion 5 cm. from the anal margin which was also biopsied. After neurosurgery treatment with phenytoin, dexametasone and whole brain radiation therapy was begun. The patient died 3 months later because of brain disease progression.DISCUSSION: Pathologic review revealed that the 3 lesions resected and/or biopsied were adenocarcinoma poorly differentiated with a immunohistochemisty profile that showed TTF1 (thyroid transcription factor) and CK 7 possitivity with CK 20, CDX-2 and thyroglobulin negativity. This immunohistochemisty profile lead to a diagnosis of primary lung adenocarcinoma with rectal and brain metastases.CONCLUSIONS: We report a rare case of synchronous rectal and brain metastasis from primary lung adenocarcinoma. Even though lung cancer metastases to the gastrointestinal tract are uncommon in the literature no rectal metastases have been described to date. In the case we present immunohistochemisty played an important role in defining the organ site of origin of the primary tumor.1) Schwartz AM, Henson DE; American College of Chest Physicians, Diagnostic surgical pathology in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007 Sep;132(3 Suppl):78S-93S.DISCLOSURE: The following authors have nothing to disclose: Pablo Romero, Carolina Barciocco, Mariano DiocaNo Product/Research Disclosure InformationInstituto Roffo, Buenos Aires, Argentina.