Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 48, Num. 3, 2002, pp. 199-200

Journal of Postgraduate Medicine, Vol. 48, Issue 3, 2002 pp. 199-200

Colonic Metastasis from Bronchogenic Carcinoma Presenting as Pancolitis

John AK, Kotru A, Pearson HJ

Department of Surgery, Diana, Princess of Wales Hospital, Grimsby DN33 2BA, UK.
Address for Correspondence: A. K. John, MS, Department of Surgery, Friarage Hospital, Northallerton, DL6 1JG, UK. E-mail: ajokjohn@yahoo.com

Code Number: jp02067

Abstract:

The colonic metastases from bronchogenic carcinoma are rare. We present a 73 years old man presented with features suggestive of pan colitis after metastasis from undifferentiated large cell carcinoma of the lung. The plain radiograph and computed tomography scan of the chest had revealed a mass lesion in the right lower lobe of lung. He had no evidence of significant lesions elsewhere. Considering the advanced stage and poor differentiation of the tumour, no active therapy was undertaken and he survived for three months. (J Postgrad Med 2002;48:199-200)

Key Words: Carcinoma, Bronchogenic, Lung neoplasms, Colon

The bronchogenic carcinoma has been reported as a cause of metastases in the colon. They may present clinically or as a finding at autopsy. We present a case of synchronous extensive metastases in the colon presenting with features of pancolitis.

Case History

A 73-years-old man presented to the colorectal clinic with a history of diarrhoea, bleeding per rectum and weight loss. He had no significant past medical illness. The clinical examination was unremarkable. A colonoscopy showed haemorrhagic inflammation, mucosal destruction, granulation tissue formation and multiple polypoidal lesions (Figure 1) in the entire length of colon suggesting pan colitis. Biopsies were taken from the colon at a distance of 70cm, 90cm, 100cm and 110cm. The plain radiograph and computed tomography (CT) scan of the chest showed a mass lesion in the right lower lobe of lung (Figure 2), which was biopsied bronchoscopically. He had no evidence of significant lesions elsewhere. The bronchial biopsy revealed an undifferentiated large cell carcinoma of the lung. The colonic biopsies were reported as metastases from this undifferentiated large cell carcinoma (Figure 3). Considering the advanced stage and poor differentiation of the tumour, no active therapy was given. He died three months after the presentation.

Discussion

Metastatic lesions in the large bowel are rare and can pose diagnostic and management difficulties. They can present as a primary tumour of the colon or with the features of a disseminated primary malignancy.^1,2 The malignancies known to cause secondaries in the large bowel are stomach, breast, ovary, cervix, kidney, lung, bladder, prostate, and melanoma. The usual presentation is with multiple metastatic deposits, but can present as solitary lesion also.

In our case, the symptoms of diarrhoea, bleeding per rectum, and endoscopic appearance of pan colitis were initially suggestive of a diagnosis of an inflammatory bowel disease. The diagnosis of the unusual disease process was revealed by the biopsy and established after the consensus in multidisciplinary (Pathology, Radiology, Oncology and Surgery) meeting. We believe the appearance of pan colitis in this case could be from the extensive tumour involvement of colonic mucosa and excessive proliferative activity of a poorly differentiated malignancy.

The colonic metastases from lung cancer may present clinically or as a finding at autopsy.³ Clinically they present with symptoms of colonic obstruction, lower gastrointestinal bleed (occult or massive), weight loss, anaemia, bowel perforation, or gastrointestinal fistula.^4-8 The usual presentation is after the diagnosis of the primary lesion, but can occur synchronously or before the diagnosis of the primary.^2,4

The lung cancer with intestinal metastasis has been reported to have poor prognosis with mean survival of only 4-8 weeks.⁹ The treatment modalities depend on the nature of presentation and extent of the disease. The colonic lesions complicated by obstruction, bleeding, or perforation has to be treated before the assessment of the lung lesion.² Depending on the extent of the disease, the treatment options are a `curative resection', palliative procedure (resection or stoma), or no active therapy.<sup>10</sup> The `curative resection' (resection of the colonic and lung lesions), in selected patients, is reported to have survival advantage.^1,10

Bronchogenic carcinoma rarely causes synchronous or metachronous metastases in the colon. In those cases, the treatment options are a `curative resection', palliative procedure, or no active therapy, depending on the extent and differentiation of the tumour. In selected cases, the `curative resection' has survival advantage.

References

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8. Polak M, Kuupryjanczyk J, Rell KW. A rare case of colonic perforation in a sole site of latent lung cancer metastasis. Pol Tyg Lek 1990;45:179-81.
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