Metástasis a colon de un carcinoma de pulmón, una presentación inusual: Reporte de un caso y revisión de la literatura / Colonic metastases from carcinoma of the lung, an unusual presentation: Case report and literature review

Las metástasis sintomáticas al colon de un carcinoma de pulmón son raras, a pesar de ser una neoplasia que representa el 12,9% de la incidencia mundial de cáncer. El colon es un sitio infrecuente de metástasis, con una prevalencia reportada menor al 0,5% en pacientes con carcinomas de pulmón, existiendo en la literatura mundial pocos casos. Es inusual que sea la forma de presentación de este tipo de neoplasia. Con respecto a las manifestaciones clínicas que se reportan pueden cursar con obstrucción intestinal como síntoma cardinal. Se presenta el caso de un paciente que curso con hemorragia de vías digestivas bajas como manifestación inicial de múltiples lesiones metastásicas a colon de un carcinoma de pulmón de célula no pequeña.

The symptomatic metastasis of the colon from a pulmonary cancer is rare; however, the global incidence of pulmonary cancer is 12.9%. It is an infrequent site of metastasis, with a prevalence of less than 0.5% in patients with pulmonary cancer. One of the most common manifestation is intestinal obstruction. We present a case report of a patient with an acute lower intestinal bleeding from multiple metastasis lesion of the colon as the initial manifestation of a non-small cell lung carcinoma.

Expression of erythropoietin and its receptor increases in colonic neoplastic progression: The role of hypoxia in tumorigenesis.

Background: Tissue hypoxia is a characteristic patho-physiologic property of colorectal cancer. This process may also add to a therapeutic problem of solid tumor resistance to chemo- and radiation therapy. Erythropoietin (Epo) expression is induced by tissue hypoxia. Acting via its receptor (EpoR), Epo inhibits apoptosis of erythroid cells and has been shown to rescue neurons from hypoxic damage. Increased Epo and EpoR expression has been recently described in human breast, renal and cervical carcinoma. Given the characteristic tumor diathesis present in majority of colorectal cancers, we examined whether Epo signaling may play a role in colonic neoplastic progression. Materials and Methods: Expression of Epo and EpoR was examined using immunohistochemistry in 24 cases of primary colorectal and metastatic adenocarcinomas versus adenomas and normal colonic mucosa. Immunohistochemical stains were evaluated semiquantitatively based on a four-tiered scale. Based on the combination of extent and intensity of immunoreactivity, an immunostaining score (0-300) was determined for each sample. Expression of Epo and EpoR protein and mRNA was examined using Western blot and reverse transcriptase-polymerase chain reaction (RT-PCR), respectively, in both normal colonic tissue and carcinoma specimens in five cases. Results: Epo expression was sequentially increased in normal colonic mucosa (8.3 ± 5.6, mean ± SEM), adenoma (26.4 ± 9.1), primary carcinoma (96.1 ± 12.8) and metastatic carcinoma (122 ± 51.3). EpoR expression was also sequentially increased in normal colonic mucosa (22.3 ± 11.8), adenoma (108.7 ± 24.2), primary carcinoma (178.7 ± 16.6) and metastatic carcinoma (220 ± 58.3) (P< 0.05 for all results). Epo and EpoR showed enhanced expression in the areas adjacent to ischemia/necrosis. Western blot and RT-PCR analysis revealed increased EpoR protein and mRNA levels in carcinoma compared to normal mucosal colon specimens. Focal stromal Epo and EpoR immunoreactivity was present in 10 and 12 cases, respectively. Conclusions: The uniform increase in the expression of Epo and EpoR along the colonic neoplastic sequence and further increase in ischemic/necrotic areas indicates that the Epo signaling pathway is an important component in colon carcinogenesis including possible epithelial-stromal interactions.

Synchronous thyroid and colon metastases from epidermoid carcinoma of the lung: case report / Metástases sincrônicas de carcinoma epidermoide de pulmão em tireoide e cólon: relato de caso

CONTEXT: Non-small cell lung cancer (NSCLC) progresses to distant metastases in most cases. The most frequent sites for distant metastases are the bones, central nervous system, adrenal glands and liver. Dissemination to the skin, myocardium, thyroid gland and intestine may occur, but is rare. CASE REPORT: We describe a case of squamous cell carcinoma in the lungs, with metastases in the colon and thyroid, in a 66-year-old female patient. The lesion was unresectable and chemotherapy was started. The patient evolved with intestinal subocclusion, and colonoscopy showed the presence of a polyp. Biopsy and immunohistochemical analysis on the polyp showed that it was compatible with squamous cell carcinoma of pulmonary origin. At a follow-up consultation, the patient presented a thyroid nodule. A aspiration biopsy and cellblock immunohistochemistry confirmed the squamous cell carcinoma of pulmonary origin. After third-line chemotherapy, the patient progressed with acute obstructive abdomen due to a retroperitoneal mass. She underwent exploratory laparotomy and died due to surgical complications. Metastases to the thyroid and colon are rarely reported in cases of epidermoid carcinoma of the lungs. Gastrointestinal involvement in pulmonary metastases may affect the stomach, small intestine and colon, and cases of bleeding and perforation have already been reported. Although richly vascularized, the thyroid is an infrequent site for metastases. Such sites reflect poor prognoses for the clinical evolution. We did not find any previous reports in the literature, on lung cancer with metastases concomitantly in the colon and thyroid, in a single patient.

CONTEXTO: O câncer de pulmão de células não pequenas evolui, na maioria dos casos, com metástases a distância. Ossos, sistema nervoso central, glândula adrenal e fígado são os sítios mais frequentes de metástases. Disseminação para pele, miocárdio, tireoide e intestino pode ocorrer, entretanto é rara. RELATO DE CASO: Descrevemos um caso de carcinoma espinocelular (CEC) de pulmão com metástase em cólon e tireoide, em mulher de 66 anos. A lesão era irressecável, e foi iniciada quimioterapia. A paciente evoluiu com suboclusão intestinal e a colonoscopia evidenciou pólipo colônico cuja biópsia e imunoistoquímica (IHQ) foram compatíveis com CEC de origem pulmonar. Em consulta de acompanhamento, detectou-se nódulo tireoidiano cuja punção aspirativa e IHQ de cellblock confirmaram CEC de origem pulmonar. Após quimioterapia de terceira linha, a paciente evoluiu com abdome agudo obstrutivo por massa retroperitoneal, sendo submetida a laparotomia exploradora, vindo a falecer por complicações da cirurgia. Metástases para tireoide e cólon são raramente reportadas em carcinomas epidermoides de pulmão. O envolvimento gastrointestinal por metástases de pulmão pode acometer estômago, intestino delgado e cólon, e casos de sangramento e perfuração já foram reportados. Embora ricamente vascularizada, a tireoide é sítio infrequente de metástases. Os sítios refletem prognósticos reservados na evolução clínica. Não encontramos, na literatura, relato prévio de câncer de pulmão com metástases em cólon e tireoide concomitantes em um único paciente.

Cáncer de riñón con metástasis a colon: un sitio poco frecuente de metástasis / Renal cell carcinoma with colon metastases: an infrequent site for metastases

BACKGROUND: Renal cell carcinoma (RCC) represents approximately 3% of malignant tumors in adults and occurs in a M:F ratio of 1.5:1.0. Although in most cases it occurs in persons 50 to 70 years of age, there are also reports in children. Clear cell carcinoma is the most frequent histological type, and 30% of renal carcinomas have metastasized at the time of diagnosis. The objective of the present study is to report colon metastasis of clear cell carcinoma that required surgery and chemotherapy. CLINICAL CASE: We report the case of a 60-year-old male with a history of metastatic RCC. His treatment consisted of cytoreductive radical nephrectomy and interferon because of pulmonary disease. He was followed-up for 8 years. Nevertheless, he presented with hematochezia and underwent colonoscopy where a splenic flexure tumor was demonstrated. Biopsy reported a clear cell tumor. We performed a left hemicolectomy. Pathology report was clear cell carcinoma with involvement of the colon from the mucosa to serosa. The patient again received interferon. Currently, there is no evidence of tumor activity and the patient is being followed-up. CONCLUSIONS: RCC metastases are most frequent in lung, liver, and bone and less frequent in brain, skin, and soft tissue. Metachromic metastases are identified in the first to second year after nephrectomy in most cases. Survival of patients who present metastasis <1 year after nephrectomy is 33 months vs. patients who present metastasis after 1 year from nephrectomy (55 months). Metastatic clear cell carcinoma requires surgery and immunotherapy. Surgery is the first step for disease control and metastatecomies are indicated in localized disease or when one organ is affected and surgically accessible.

Metastasis de carcinoma de mama en ileon-colon y vesicula biliar simulando enfermedades inflamatórias / Breast carcinoma metastasis in ileum-colon and gallbladder simulating inflammatory diseases

Las metástasis en aparato digestivo, extrahepático son poco frecuentes y se caracterizan por presentarse luego de un período de latencia largo que va de 3 a 20 años, sus síntomas son inespecíficos y simulan enfermedades inflamatórias o segundo tumor. El subtipo histológico más común es el carcinoma lobulillar. Presentamos dos casos de metástasis de carcinoma de mama, uno en íleo-colon y otro en vesícula biliar. Ambas pacientes comenzaron con síntomas que llevaron a diagnósticos de enfermedad de Crohn en el primero y de colecistitis aguda en el caso dos. El diagnóstico se realizó en las piezas quirúrgicas, donde se observaron células de carcinoma lobulillar que infiltraban desde la serosa hasta la mucosa inclusive y con la inmunomarcación que resultaron BCA225, Estrógeno y Progesterona positivos. El tratamiento con radioterapia, quimioterapia u hormonal, mejora la calidad de vida, pero el promedio de sobrevida luego del diagnóstico es de un año.

Colectomías video-asistidas / Video assisted colectomies

Se presentan 18 enfermos en los que se pudo realizar la colectomía video-asistida en 13 (72 por ciento). En los 5 restantes (28 por ciento) hubo que convertir por punción de la arteria ilíaca, imposibilidad de ubicar la lesión, cánceres avanzados que invadían la vejiga y la pared abdominal y por metástasis hepática que requirió resección. La edad promedio fue de 65 años. Cinco se intervinieron por patología colónica benigna y 13 por cáncer de colon. Se exterioriza el colon por manilaparotomía y se ejecuta la anastomosis extra-abdominal o endo-abdominal con doble sutura mecánica. Hubo 2 complicaciones importantes: punción de la arteria ilíaca y lesión duodenal. La deambulación se produjo entre las 12 y 18 horas, el alta hospitalaria a los 4,7 días y los pacientes reasumieron sus actividades a los 8,6 días. No hubo mortalidad operatoria ni postoperatoria inherente al procedimiento. En los enfermos intervenidos por cáncer se encontraron entre 8 y 14 ganglios en las piezas de resección. Seguidos entre 7 y 39 meses ninguno de estos pacientes ha presentado recidivas abdominales ni parietales

Coriocarcinoma puro, primario, del ovario: presentación de un caso / Primary ovarian choriocarcinoma: a case presentation

El cariocarcinoma del ovario originado en las células germinales es una neoplasia maligna extraordinariamente rara. En su forma pura se han comunicado muy pocos casos en la literatura médica. El coriocarcinoma ovárico puede originarse bajo tres modalidades diferentes: 1) Como un cariocarcinoma primario asociado a un embarazo ovárico. 2) Como un coriocarcinoma ovárico metastásico de otros órganos, principalmente del útero. 3) Como un tumor primario de células germinales con diferenciación hacia estructuras trofoblásticas. Este último se desarrolla en las niñas o en la mujer adulta, generalmente joven, en donde necesariamente tiene que excluirse el embarazo. Se presenta el caso de una mujer de 21 años, tratada en el Hospital General "Dr. Miguel Silva", SSA de Morelia, Mich. soltera, sin vida sexual, con una tumoración abdomino-pélvica de 24 cm., proveniente del ovario derecho y adherida al colon ascendente. La subunidad beta de gonadotropina coriónica era de 200,000 mUI/ml. de plasma sanguíneo. En la laparotomía se encontró una tumoración del ovario derecho, con infiltración al colon ascendente, que requirió histerectomía total con salpingooferectomía bilateral y hemicolectomía derecha. Después de la cirugía la paciente recibió quimioterapia a base de cisplatino, bleomicina y vinblastina. Después del tercer ciclo de tratamiento y a los 3 meses de operada, la gonadotropina coriónica se negativizó y a los 4 años de seguimiento, no se ha demostrado actividad tumoral residual. La mortalidad mayor en estos tumores se presenta en el postoperatorio temprano y es atribuida al tumor mismo o a las complicaciones postoperatorias. Si la paciente sobrepasa esta etapa y se instala un eficaz esquema quimioterápico, la sobrevida y aún la curación coronan los esfuerzos terapéuticos