Metastatic lung carcinoma presenting as intussusception of the ascending colon

Abstract

Introduction: Lung cancer remains a leading cause of cancer deaths worldwide, and an estimated 50% of cases are associated with metastasis at the time of diagnosis. We present the case of a 45-year-old female smoker with a history of right upper lobectomy with radiation for lung adenocarcinoma who, nine months later, presented with abdominal pain and was found to have an isolated metastatic lesion to the cecum causing intussusception.

Case description: A 45-year-old woman presented with a two-day history of abdominal pain, melena, fever, and chills. A diagnostic workup revealed a mass in the cecum and a colocolic intussusception. The patient underwent right hemicolectomy and was discharged following a slow recovery. Microscopic examination of the lesion revealed an adenocarcinoma histologically identical to the primary lung tumor. Further workup failed to uncover any further evidence of disease. The patient continues to be well after 23 years of clinical follow-up.

Discussion: Metastasis to the colon is a rare event but represents advanced disease and the prognosis is poor. Symptomatic involvement of the colon has only been reported in fourteen previous cases.

Conclusions: Although uncommon, metastatic disease from lung to colon should be considered in patients with lung and large bowel masses diagnosed within a relatively short time course. More likely are synchronous primaries or colon metastasis to the lung, but an accurate diagnosis is critical. Lung metastasis to the bowel portends a poor prognosis, but isolated metastatic disease can be surgically resected for cure as demonstrated in our case.