Louisiana State University Health Sciences Center Shreveport, LA, United States
Nazar Hafiz, MD1, Aditya Vyas, MD1, Kabir Husain, DO2, Hidehiro Takei, MD1, James Morris, MD1, Paul Jordan, FACG1, Sudha Pandit, MD1 1Louisiana State University Health Sciences Center, Shreveport, LA; 2LSU Health Shreveport, Shreveport, LA
Introduction: Small bowel metastatic diseases from primary lung carcinoma are extremely uncommon. These metastatic complications are usually asymptomatic but can present as mechanical obstruction, bowel perforation or hemorrhage. We present a case of a gentleman who presented with melena and was found to have primary lung non-small cell cancer with metastasis to duodenum.
Case Description/Methods: A 62 y. o. gentleman, chronic tobacco user, presented to the ER with complaints of fatigue, exertional SOB and intermittent melena one month prior to presentation. Pt also reported intermittent hemoptysis. On initial evaluation he was found to have leukocytosis, thrombocytosis and anemia. EGD was done which showed multiple, cratered, irregular ulcers in the 2nd and 3rd part of duodenum, each measuring around 10 mm x 15 mm. Multiple biopsies were taken for pathology resulting in non-small cell carcinoma. CXR showed a large right hilar mass followed by CT scan of chest revealing 7x7 cm parenchymal mass with internal calcification arising from the right lower lobe and causing anterior displacement of bronchi. He underwent a bronchoscopy with biopsies of hilar mass resulting in undifferentiated non-small cell carcinoma. Oncology service was consulted for further management.
Discussion: Secondary small bowel metastatic lesions usually arise from primary cancers of gastrointestinal tract and genital organs like colon, testes, ovaries and cervix. Lung tumors metastasizing to small bowels are less frequently encountered. Patients presents with signs of upper or lower GI bleeding. Some patients present with signs of intestinal obstruction/perforation. Small bowel secondary metastases from primary lung cancer, presenting with GI bleed as an initial presentation usually suggest a poor prognosis. As clinicians we should be aware of rare differentials of multiple duodenal ulcers presenting with melena.
Figure: Histopathology showing intact mucosa with tumor cells present in lamina propria. Endoscopy images showing duodenal ulcers
Nazar Hafiz indicated no relevant financial relationships.
Aditya Vyas indicated no relevant financial relationships.
Kabir Husain indicated no relevant financial relationships.
Hidehiro Takei indicated no relevant financial relationships.
James Morris: Celgene – Grant/Research Support.
Paul Jordan indicated no relevant financial relationships.
Sudha Pandit indicated no relevant financial relationships.
Nazar Hafiz, MD1, Aditya Vyas, MD1, Kabir Husain, DO2, Hidehiro Takei, MD1, James Morris, MD1, Paul Jordan, FACG1, Sudha Pandit, MD1. P1999 - Duodenal Ulcer Masquerading as Non Small Cell Lung Cancer, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.