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Lung Cancer |

Intussusception: A Rare Presentation of Non-small Cell Lung Cancer

Vipin Mittal*, MD; Anish Shah, MD; Arya Karki, MD; Muhammad Ali, MD; Amer Akmal, MD; Walid Baddoura, MD
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St Joseph's Regional Medical Center, Paterson, NJ


Chest. 2012;142(4_MeetingAbstracts):566A. doi:10.1378/chest.1390462
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Abstract

SESSION TYPE: Cancer Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Non-small cell lung cancers (NSCLC) constitute between 85 to 90 % of all lung cancers; the rest 10 to 15 % are small cell lung cancers. Extrathoracic metastasis to brain, bones, liver, bone marrow, lymph nodes & adrenal glands is well known in case of non-small cell lung cancer (1).

CASE PRESENTATION: A 56-year-old African American gentleman with no past medical history presented with complaint of constipation associated with progressively worsening left periumbilical pain and one episode of vomiting undigested food material. He reported decreased appetite and 15 pounds weight loss in last few months. He had 40 pack year history of smoking and occasional alcohol intake. On physical examination he was afebrile with stable vital signs, had mild tenderness in the left periumbilical location with no guarding or rigidity. CT scan of abdomen revealed a long segment of intussusception involving proximal jejunal loop in left hemiabdomen leading to proximal small bowel obstruction secondary to a submucosal mass. CT scan of the chest revealed severe emphysema with bullous changes and a 1.4 cm spiculated mass in left apex along with bilateral necrotic appearing hilar lymphadenopathy (Image 1). Patient underwent exploratory laparotomy during which the diseased part of small intestine (fungating, friable mass measuring 6.0 x 4.2 x 3.8 cms) and part of the attached mesentery (with multiple lymph nodes enlargement) were resected. Histopathology revealed poorly differentiated neoplasm and immunohistochemical markers (positive for CD34, cytokeratin & vimentin, negative for CD117, CK20) were consistent with a metastatic non-small cell carcinoma (Image 2). An MRI of the brain also revealed vasogenic edema with five enhancing lesions compatible with metastatic disease. Patient was started on palliative chemotherapy and radiotherapy (whole brain irradiation) and discharged from the hospital with outpatient follow ups.

DISCUSSION: Intussusception is an “internal prolapse” of the bowel that leads to obstruction and compromise of mesenteric blood flow, with resultant inflammation and the potential for ischemia of the bowel wall (2). Surgical resection is recommended because of the high percentage of associated malignancy (3).

CONCLUSIONS: Adult intussusception is rare accounting for 1 to 5% of bowel obstruction and commonly involves a distinct pathologic lead point, which is malignant in over half of the cases (3). Hence, adult patient with intussusception should be evaluated for underlying malignancy.

1) Kuo CW et al. Non-small cell lung cancer in very young and very old patients. Chest 2000; 117:354.

2) Marinis A et al. Intussusception of the bowel in adults: a review. World J Gastroenterol 2009; 15:407.

3) Nagorney DM et al. Surgical management of intussusception in the adult. Ann Surg 1981; 193:230.

DISCLOSURE: The following authors have nothing to disclose: Vipin Mittal, Anish Shah, Arya Karki, Muhammad Ali, Amer Akmal, Walid Baddoura

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St Joseph's Regional Medical Center, Paterson, NJ

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