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      18F‐FDG PET/CT imaging of small intestinal metastasis from pulmonary sarcomatoid carcinoma: Brief report and review of the literature

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          Abstract

          We herein report two cases of small intestinal metastasis from pulmonary sarcomatoid carcinoma (PSC) detected by 18F‐fluorodeoxyglucose positron emission tomography/computed tomography ( 18F‐FDG PET/CT). We reviewed the literature on 18F‐FDG PET/CT features in gastrointestinal metastasis of PSC patients since 1992, and further analyzed the imaging features. According to the literature review, 23 eligible cases were identified from eight studies, and no cases underwent 18F‐FDG PET/CT imaging. In this study, clinical and PET/CT imaging data of two patients are reported. In our cases, clinical and the CT images of lung masses were not typical, but the uptake of 18F‐FDG was remarkably high, with SUVmax exceeding 30. Small intestinal metastases may not be related to obstruction, or even the local intestinal cavity may be dilated. Therefore, in PSC patients with mild or without abdominal symptoms, 18F‐FDG PET/CT imaging could identify intestinal metastasis at a relatively early stage and may be used to determine the preferred biopsy site, or early intervention by surgery.

          Key points

          18F‐FDG PET/CT imaging of small intestinal metastasis of PSC has not been previously reported in the literature and here we report the 18F‐FDG PET/CT features of two cases.

          The uptake of 18F‐FDG was remarkably high in both the primary tumor and metastatic intestinal lesion. 18F‐FDG PET/CT imaging may therefore be used to determine the preferred biopsy site or early intervention by surgery.

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          Most cited references15

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          Gastrointestinal metastases from primary lung cancer.

          The aim of this study was to evaluate gastrointestinal metastases from primary lung cancer confirmed by autopsy. We identified and examined patients with a diagnosis of primary lung cancer over 33 years. We also reviewed patients with gastrointestinal metastases including the stomach, small bowel, and large bowel. This study comprised 470 patients with lung cancer. We detected 56 (11.9%) cases with gastrointestinal metastases. There were 12 (30%) cases with gastrointestinal metastases among 40 cases with large cell carcinoma. The histological type of large cell carcinoma led to a significantly higher rate of gastrointestinal metastases compared with that of non-large cell carcinoma (P=0.004, odds ratio 3.524). Life threatening gastrointestinal metastases occurred in 12 cases and five occurred in large cell carcinoma. Gastrointestinal metastases from primary lung cancer may occur in the clinical course and result in life threatening gastrointestinal metastases, particularly if patients have the histological type of large cell carcinoma.
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            Gastrointestinal metastasis of lung cancer with special emphasis on a long-term survivor after operation.

            The aim of this study was to report the clinical characteristics and outcomes of gastrointestinal metastasis from lung cancer, with special emphasis on a long-term survivor after surgery. We retrospectively reviewed all patients diagnosed with lung cancer between 2000 and 2007 at a tertiary referral center for cancer. Gastrointestinal metastases were detected in 10 (0.19%) of 5,239 lung cancer patients. Small bowel metastases occurred in one-half of the patients, making it the most common metastatic site. One patient underwent emergency surgery because of an intestinal perforation. Although a perforation developed only in this patient, surgical intervention was required for five other patients to relieve intestinal obstruction or control bleeding. The prognosis was poor, with a median survival of 96.5 days after diagnosis. However, one patient remains alive >5 years post-operatively, without a recurrence, suggesting that surgical resection is an option for cure in properly selected patients. Physicians should be familiar with unique features of lung cancer with metastasis to the gastrointestinal tract so as to render early and optimal management.
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              Primary lung cancer presenting with gastrointestinal tract involvement: clinicopathologic and immunohistochemical features in a series of 18 consecutive cases.

              Lung cancer initially manifesting as gastrointestinal (GI)-tract metastasis is exceedingly rare, representing a diagnostic challenge and a late-stage disease sign. The clinicopathologic characteristics of the largest series of lung carcinomas initially presenting with GI involvement were described, focusing on differential diagnosis and therapeutic options. Eighteen consecutive cases of lung cancer (11 surgical specimens and 7 biopsies) initially diagnosed on GI histologic samples were identified during routine pathologist practice. All cases were immunostained with thyroid transcription factor-1 (TTF-1), caudal-related homeobox 2 (CDX2), and cytokeratins 7 (CK7) and 20 (CK20). Clinical and radiological data were obtained in all cases. There were 10 women and 8 men with a mean age of 68.5 years. The small bowel was the most common GI involved site (12 cases), followed by the stomach (four) and large intestine (two). Only half of cases were correctly diagnosed on GI biopsies. Fourteen patients died shortly from disease (mean follow-up, 3 months); two are still alive with multiple metastases, and two patients with the GI tract as the unique site of metastasis underwent pulmonary lobectomy and chemotherapy and are alive without evidence of disease. At morphology, there were 10 large cell undifferentiated carcinomas and eight adenocarcinomas. All cases were immunostained for CK7 and 89% for TTF-1, whereas CK20 and CDX2 were completely negative. Lung cancer presenting as GI-tract metastasis is probably more frequent than expected, and pathologists should always keep in mind this possibility when dealing with undifferentiated GI carcinoma. Immunostaining with TTF-1, CDX2, CK7, and CK20 is helpful in highlighting lung primary. Although GI metastasis from lung cancer is associated with dismal outcomes, pulmonary resection coupled with chemotherapy might represent a therapeutic option in selected patients with a solitary GI-tract metastasis.
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                Author and article information

                Contributors
                xmhan@zzu.edu.cn
                bulihongs@whu.edu.cn
                Journal
                Thorac Cancer
                Thorac Cancer
                10.1111/(ISSN)1759-7714
                TCA
                Thoracic Cancer
                John Wiley & Sons Australia, Ltd (Melbourne )
                1759-7706
                1759-7714
                15 May 2020
                August 2020
                : 11
                : 8 ( doiID: 10.1111/tca.v11.8 )
                : 2325-2330
                Affiliations
                [ 1 ] Department of Nuclear Medicine the First Affiliated Hospital of Zhengzhou University Zhengzhou China
                [ 2 ] PET‐CT/MRI Center & Molecular Imaging Center Wuhan University Renmin Hospital Wuhan China
                [ 3 ] The 1 st Department of Gastrointestinal Surgery Wuhan University Renmin Hospital Wuhan China
                [ 4 ] Molecular Imaging Program at Stanford (MIPS), Department of Radiology and Bio‐X Program Stanford University Stanford California USA
                Author notes
                [*] [* ] Correspondence

                Xingmin Han, Department of Nuclear Medicine, the First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Molecular Imaging, 1 Eastern Jianshe Road, Erqi District, Zhengzhou, Henan 450052, China.

                Tel: 086‐13838178090

                Fax: 086‐371‐66913059

                Email: xmhan@ 123456zzu.edu.cn

                Lihong Bu, PET‐CT/MRI Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.

                Tel: 086‐15827556358

                Fax: 086‐27‐88076858

                Email: bulihongs@ 123456whu.edu.cn

                [†]

                These two authors contribute equally to this article.

                Author information
                https://orcid.org/0000-0002-1102-3158
                Article
                TCA13468
                10.1111/1759-7714.13468
                7396377
                32410331
                0b79ed50-24ee-4ac9-b219-0ae276aec0da
                © 2020 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 March 2020
                : 15 April 2020
                : 18 April 2020
                Page count
                Figures: 4, Tables: 1, Pages: 6, Words: 3603
                Funding
                Funded by: Chinese Society of Clinical Oncology Foundation
                Award ID: Y‐HR2016‐44
                Funded by: Hubei Provincial Health Department , open-funder-registry 10.13039/501100010846;
                Award ID: WJ2017M012
                Funded by: Hubei Provincial Natural Science Foundation of China
                Award ID: 2017CFB781
                Funded by: National Natural Science Foundation of China , open-funder-registry 10.13039/501100001809;
                Award ID: 81871419
                Funded by: Seed project in Sino foreign joint research platform of Wuhan University
                Award ID: 2309‐413100006
                Funded by: Young Teachers’ Independent Research Funding of Wuhan University
                Award ID: 2042019kf0054
                Categories
                Brief Report
                Brief Reports
                Custom metadata
                2.0
                August 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.6 mode:remove_FC converted:02.08.2020

                18f‐fluorodeoxyglucose,non‐small cell lung cancer,positron emissiontomography/computed tomography,pulmonary sarcomatoid carcinoma,small intestinal metastasis

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