title: Single symptomatic colonic metastasis as first presentation of a pulmonary mucoepidermoid carcinoma.
abstract: Metastatic lesions in the large bowel are rare. A case of single symptomatic colonic metastasis as first presentation of pulmonary mucoepidermoid carcinoma (MEC) is described. A 62-year-old male was admitted with constipation and rectal bleeding. Colonoscopy revealed extrinsic compression at sigmoid colon, and microscopy suggested a secondary origin. Subsequent chest computed tomography confirmed a right perihilar mass invading posterior mediastinum, carina and esophagus, and also a second consolidation on right lower lobe and ipsilateral mediastinal and subcarinal lymph nodes. After pathologic evaluation of a transthoracic biopsy specimen, the diagnosis of pulmonary high-grade MEC, stage IV (T4, N3, M1b - 7th ed. TNM), was established. Chemotherapy with carboplatin and paclitaxel was initiated, and disease progression occurred after two cycles with increasing colonic mass. Palliative surgery was rejected because of advanced stage, and the patient was submitted to palliative pelvic radiotherapy. Second-line chemotherapy with gemcitabine was initiated, but clinical status worsened and the patient died because of severe lung failure. Clinical, pathological and therapeutic aspects of this uncommon site of extrathoracic metastatic disease are discussed, emphasizing the important contribution of special stains and immunohistochemistry to the diagnosis.
authors.affiliation: Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Franco
authors.affiliation: Department of Anatomic Pathology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
authors.forename: David
authors.initials: D
authors.lastname: Tente
authors.affiliation: Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
authors.forename: Daniel
authors.initials: D
authors.lastname: Coutinho
authors.affiliation: Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Linhas
authors.affiliation: Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Antunes
authors.affiliation: Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Barroso
mesh_terms: D018277:Carcinoma, Mucoepidermoid / Q000175:diagnosis* / Q000628:therapy; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D003113:Colonoscopy; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017211:Treatment Failure
keywords: colonic metastasis; gastrointestinal metastases; immunohistochemistry; lung cancer; pulmonary mucoepidermoid carcinoma