폐선암의 위장, 십이지장 및 대장 원격성 전이 1예
A Case of Gastric, Duodenal and Colonic Metastases from Adenocarcinoma of the Lung
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원발성 폐암의 위장관 전이 빈도는 부검을 통한 연구에서 4.7∼14%이지만 실제 임상에서의 보고는 드물다. 81세 남자가 전산화 단층 촬영에서 폐, 부신, 방광, 대장에 종괴가 발견되어 내원하였다. 저자들은 원인 불명암을 의심하고 원발암의 감별을 위해 위 및 대장 내시경을 시행하였고 위와 대장에서 중심에 미란을 동반하는 점막하 종양 형태의 병변과 십이지장에서 중심에 균열을 동반한 용종 형태의 병변을 발견하였다. 조직 검사에서 표면 샘의 침범이 없는 저분화 선암종이었다. 면역 화학 검사에서 cytokeratin 7, thyroid transcription factor-1에 양성, cytokeratin 20, caudal-related homeobox 2에 음성을 보여 원발성 폐선암의 다발성 위장관 전이로 진단하였다. 저자들은 위장, 소장, 대장에 동시에 원격성 전이를 일으킨 폐선암을 경험하여 보고한다.
Abstract
Gastrointestinal metastasis of primary lung carcinoma is very rare, although this is found in about 4.7∼14% of cases at autopsy. An 81-year-old man was admitted with masses in the lung, adrenal gland, bladder and colon on his CT scans. We suspected metastases of an unknown origin and we carried out EGD and colonoscopy to differentiate the primary origin of the metastases. The examination revealed a submucosal tumor-like mass with central erosion on the gastric antrum and colonic splenic flexure, and polypoid lesions with a central fissure on the second portion of the duodenum. All the endoscopic forcep biopsies showed poorly differentiated adenocarcinoma without evidence of foci of the preinvasive surface glandular lesions. Immunochemical analysis of the tumor cells showed positivity for thyroid transcription factor-1 and cytokeratin 7, and negativity for cytokeratin 20 and caudal-related homeobox 2. Therefore, we diagnosed this case as multiple gastrointestinal metastases of primary lung cancer. This is first case of gastric, duodenal and colonic metastases from adenocarcinoma of the lung in the medical literature.
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