Small bowel metastases in non-small cell lung cancer

A case report of stage I adenocarcinoma of the lung in a 43-year-old female with recurrence in the small bowel and liver 11 months after pneumonectomy is presented. In addition, a cohort of 733 patients with non-small cell lu ng cancer (NSCLC) in all pretreatment stages (stages I-IV) with a total of 218 autopsies are evaluated, and the literature on the topic is reviewed, i n order to define the frequency of metastases from NSCLC to the small bowel . There were 10 cases with and 208 cases without small bowel involvement am ong 218 consecutive autopsies (autopsy rate, 30%). The frequency of small b owel involvement was 4.6% (95% confidence interval, 2.2-8.3%), and all were in patients with adenocarcinoma of the lung. Ail patients with small bowel involvement at autopsy had also other concurrent metastatic sites as well and the following were the most frequent: adrenals (90% of cases), mediasti nal lymph nodes (80%), liver (70%), pleura (60%), contralateral lung (60%), bones (60%), and brain (50%). Significantly more metastatic sites were obs erved in patients with than without small bowel involvement, both totally ( P = 0.0001) and with respect to number of extrathoracic (P = 0.0001) and in trathoracic (P = 0.01) metastatic sites. In conclusion, small bowel involve ment in NSCLC is relatively infrequent. As a unique finding, over-represent ation of patients with poorly differentiated tumors (P = 0.03) and patients having solid carcinoma with mucus formation after histologic subtyping (P = 0.04) among cases with small bower involvement was observed. This indicat es, that small bowel metastases is an epiphenomonen of NSCLC tumors with ce rtain biological characteristics, although as yet undiscovered, which leads to a high metastatic potential. If such biological characteristics could b e identified, they may be used in the selection of treatment options for in dividual patients, e.g. indicating a need for adjuvant or neoadjuvant chemo therapy in addition to surgery in resectable or marginally resectable NCSLC patients. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.