Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 7, Number 9, September 2016, pages 411-415

Asymptomatic Duodenal Metastasis From Small Cell Lung Cancer Diagnosed by Endoscopic Ultrasound-Guided Fine-Needle Aspiration

Figures

Figure 1.
Figure 1. Computed tomography (CT) shows a 60-mm mass shadow in the right lung hilar region.
Figure 2.
Figure 2. Positron emission tomography (PET) shows accumulation of fluorodeoxyglucose (FDG) in the duodenal descending limb (a). Mildly enhanced mass was detected in the same position on contrast-enhanced computed tomography (CT) (b).
Figure 3.
Figure 3. Upper gastrointestinal endoscopic examination shows a huge submucosal tumor (SMT) in the duodenal descending limb.
Figure 4.
Figure 4. The submucosal tumor (SMT) was visualized as 30 mm in size, round-shaped, homogeneous, and low echoic mass (arrowheads) connected with fourth layer of duodenal wall (arrows) on radial type endoscopic ultrasound (EUS) (a). EUS-guided fine-needle aspiration (FNA) was performed for the SMT (b).
Figure 5.
Figure 5. HE (hematoxylin and eosin)-stained sections of specimens obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) show relatively small atypical cells with a high nuclear/cytoplasm ratio (a), similar to those of the primary lung lesion (b).
Figure 6.
Figure 6. Tumor cells are diffusely positive for cluster of differentiation 56 (CD56) (a) and thyroid transcription factor 1 (TTF-1) (b) and focally positive for chromogranin (c), similar to those obtained from the primary lung lesion under bronchoscopy (d: CD56; e: TTF-1; f: chromogranin).

Table

Table 1. Clinical Characteristics of Patients With Small Bowel Metastases From Small Cell Lung Cancer Diagnosed While Alive
 
CaseYearAuthor, referenceAge (years)SexReason for investigationCondition of small intestineTissue samplingLocationOther metastatic sites
PET: positron emission tomography; EUS-FNA: endoscopic ultrasound-guided fine-needle aspiration.
12006Yang et al [8]57MAbdominal painBowel obstructionSurgeryIleumBrain, peritoneum
22006Kanemoto et al [3]71MAnemiaBleedingSurgeryIleumAdrenal gland
32009Guerin et al [10]69MAbdominal painPerforationSurgeryJejunumPeritoneum
42009Scabini et al [11]76MAbdominal pain, feverBowel obstructionSurgeryIleumUnknown
52012Jarmin et al [12]75MAnemia, malaiseBleedingSurgeryDuodenum, jejunumNone
Our case--67MPET-EUS-FNADuodenumBone