title: Usefulness of immunohistochemical studies in diagnosing metachronous gallbladder and small intestinal metastases from lung cancer with gastrointestinal hemorrhage: a case report.
abstract: Isolated metachronous gastrointestinal metastases from advanced-stage lung cancer are rarely diagnosed on the basis of symptoms and resected. In this report, we present a case of resectable metachronous gallbladder and small intestinal metastases of lung cancer. An 86-year-old woman was treated for lung cancer with resection of the right inferior lobe. Five months after the surgery, she was re-admitted because of melena and anemia. Ultrasonography showed a gallbladder tumor with gastrointestinal hemorrhage, and laparoscopic-assisted cholecystectomy was subsequently performed. However, 2 months after this event, the patient presented again with melena and anemia and was diagnosed with a small intestinal tumor. Therefore, laparoscopic-assisted partial resection of the small intestine was performed. Immunohistochemical staining for thyroid transcription factor-1 and cytokeratin 7 confirmed that the two resected tumors were metachronous metastases of the primary lung cancer. The patient died of liver metastases 5 months after the last surgery. Our experience with this case suggests that surgical resection might not be curative but palliative for patients with isolated gallbladder and small intestinal metastases diagnosed on the basis of melena that is resistant to conservative treatment.
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. masa_psg@hotmail.com.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. dragonpegasus@a3.keio.jp.
authors.forename: Minoru
authors.initials: M
authors.lastname: Kitago
authors.affiliation: Department of Surgery, Kyosai Tachikawa Hospital, 4-2-22 Nishiki, Tachikawa, Tokyo, 190-8531, Japan. y.akiyama@tachikawa-hosp.gr.jp.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Akiyama
authors.affiliation: Department of Surgery, Kyosai Tachikawa Hospital, 4-2-22 Nishiki, Tachikawa, Tokyo, 190-8531, Japan. iwamaru@zb3.so-net.ne.jp.
authors.forename: Arifumi
authors.initials: A
authors.lastname: Iwamaru
authors.affiliation: Department of Surgery, Kyosai Tachikawa Hospital, 4-2-22 Nishiki, Tachikawa, Tokyo, 190-8531, Japan. t.yamamoto@tachikawa-hosp.gr.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Kyosai Tachikawa Hospital, 4-2-22 Nishiki, Tachikawa, Tokyo, 190-8531, Japan. f.suzuki@tachikawa-hosp.gr.jp.
authors.forename: Fumio
authors.initials: F
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. taizohibi@z3.keio.jp.
authors.forename: Taizo
authors.initials: T
authors.lastname: Hibi
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. abey3666@gmail.com.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. hy0624@gmail.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagi
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. masa02114@yahoo.co.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shinoda
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. laplivertiger@gmail.com.
authors.forename: Osamu
authors.initials: O
authors.lastname: Itano
authors.affiliation: Department of Pathology, Kyosai Tachikawa Hospital, 4-2-22 Nishiki, Tachikawa, Tokyo, 190-8531, Japan. ogata-k@tachikawa-hosp.gr.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ogata
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. kitagawa@a3.keio.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005706:Gallbladder Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007124:Immunoenzyme Techniques; D007414:Intestinal Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology*; D008113:Liver Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D008175:Lung Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor