Multiple metastases to the small bowel from large cell bronchial carcinomas.
OBJECTIVE
Metastases from lung cancer to gastrointestinal tract are not rare at postmortem studies but the development of clinically significant symptoms from the gastrointestinal metastases is very unusual.


METHODS
Formalin-fixed, paraffin-embedded tissues were cut into 5 microm thick sections and routinely stained with hematoxylin and eosin. Some slides were also stained with Alcian-PAS. Antibodies used were primary antibodies to pancytokeratin, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, vimentin, smooth muscle actin and CD-117.


RESULTS
We observed three patients who presented with multiple metastases from large cell bronchial carcinoma to small intestine. Two of them had abdominal symptoms (sudden onset of abdominal pain, constipation and vomiting) and in one case the tumor was incidentally found during autopsy. Microscopically, all tumors showed a same histological pattern and consisted almost exclusively of strands and sheets of poorly cohesive, polymorphic giant cells with scanty, delicate stromas. Few smaller polygonal anaplastic cells dispersed between polymorphic giant cells, were also observed. Immunohistochemistry showed positive staining of the tumor cells with cytokeratin and vimentin. Microscopically and immunohistochemically all metastases had a similar pattern to primary anaplastic carcinoma of the small intestine.


CONCLUSIONS
In patients with small intestine tumors showing anaplastic features, especially with multiple tumors, metastases from large cell bronchial carcinoma should be first excluded, because it seems that they are more common than expected.
Tomas
Davor
D
Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Vinogradska 29, 10000 Zagreb, Croatia.
Ledinsky
Mario
M
Belicza
Mladen
M
Kruslin
Bozo
B
D000708:Anaplasia / Q000473:pathology; D001984:Bronchial Neoplasms / Q000473:pathology*; D018287:Carcinoma, Large Cell / Q000556:secondary*; D005260:Female; D015726:Giant Cells / Q000473:pathology; D006801:Humans; D007414:Intestinal Neoplasms / Q000556:secondary*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged