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A Cryptic Culprit of Gastrointestinal Intussusception and Hemorrhage From Above the Diaphragm: Sarcomatoid Lung Cancer FREE TO VIEW

Tamara Rodriguez, MD; Benjamin Wu, MD; William Bender, MD; Ravindra Rajmane, MD
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New York University Medical Center, New York City, NY

Chest. 2014;146(4_MeetingAbstracts):622A. doi:10.1378/chest.1993716
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SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: A case report of an unique presentation of sarcomatoid lung carcinoma.

CASE PRESENTATION: The patient is a 52 year old Chinese man with a history of tobacco exposure who presented to the emergency department with melena and loss of consciousness. He relates 1 month of dyspnea on exertion and scant hemoptysis for 10 months. Severe anemia was noted on laboratory results. Gastrointestinal endoscopic evaluation was unremarkable. Small bowel obstruction from Ileoileal intussusception was found on abdominal CT. Exploratory laparotomy revealed a tumor in the proximal small bowel. Pathology revealed poorly differentiated metastatic lung carcinoma with sarcomatoid features. Tumor cells stained positive for TTF1 and vimentin, and focally positive for AE1/3, CK7, and EMA. The cells were negative for desmin, myogenin, S100, CD10, and thyroglobulin. A bronchoscopic lung evaluation and biopsy was non-diagnostic. The final diagnosis was non-small cell lung cancer with sarcomatoid features with metastasis to the small bowel.

DISCUSSION: The gastrointestinal tract is an uncommon site for lung cancer metastases.1 Our case is describes a rare presentation of a gastrointestinal bleed as the presenting symptom of a patient with no previous diagnosis of lung cancer. Our patient was also found to have a rare cause of lung cancer. Sarcomatoid carcinoma accounts for only 0.3% of all lung malignancies.2 These lung cancers carry significant mortality and morbidity. Many of these carcinomas present in later stages of the disease process. The patient described in our case was unexpectedly diagnosed with lung cancer only after the development of gastrointestinal symptoms. Clinically significant metastases, specifically intussusception, highlight the need for the clinician to have a high index of suspicion for extraordinary causes of peculiar presentations.

CONCLUSIONS: Sarcomatoid lung cancers are rare malignancies that may have unique gastrointestinal presentations.

Reference #1: Hillenbrand A, Sträter J, Henne-Bruns D.Frequency, symptoms and outcome of intestinal metastases of bronchopulmonary cancer. Case report and review of the literature. Int Semin Surg Oncol. 2005 Jun 6;2:13.

Reference #2: Travis WD. Sarcomatoid neoplasms of the lung and pleura. Arch Pathol Lab Med. 2010 Nov;134(11):1645-58. doi: 10.1043/2010-0086-RAR.1.

DISCLOSURE: The following authors have nothing to disclose: Tamara Rodriguez, Benjamin Wu, William Bender, Ravindra Rajmane

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