PMC3971873_01
CT scanning images. (a) Lung cancer in the left-upper lobe measuring 7.8 cm in diameter. The tumour invaded both the pleura and the outer layer of the descending aorta. Central necrosis was shown. (b) A metastatic tumour in the sigmoid colon. (c) During chemotherapy, the tumour in the sigmoid colon decreased in size, whereas the primary lung tumour and other metastatic tumours were unchanged. (d) Four months after the diagnosis of lung cancer, the sigmoid colon tumour was enlarged again.
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figure1
CT scanning revealed a tumour in the left-upper lobe of the lung of 7.8 cm in diameter (Figure 1a). The surface layer of the tumour showed enhancement with contrast media, but most of the tumour itself lacked enhancement (Figure 1b). In addition, CT scanning showed the primary lung tumour and metastatic tumours to be unchanged, except that the sigmoid colon tumour had obviously regressed to 0.8 cm in diameter (Figure 1c). CT scanning performed a day before his death revealed that the primary lung tumour and metastatic tumours remained unchanged in size, but the sigmoid colon tumour was enlarged again to 1.8 cm in diameter (Figure 1d).
Positron emission tomography scanning showed tracer uptake in the sigmoid colon tumour. Central necrosis was observed.
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figure2
Because tracer accumulation was seen in the peripheral part of the sigmoid colon tumour (Figure 2), a tumour with central necrosis was highly suspected.
Histological examinations of the lung tumour. (a) Atypical cells with a high nuclear-cytoplasmic ratio were observed in the biopsied specimen (haematoxylin and eosin staining). (b) These cells were positive for cytokeratin AE1/AE3, (c) thyroid transcription factor-1, and (d) synaptophysin, but were negative for (e) chromogranin A and (f) CD56 (original magnifications: x20). These results were consistent with adenocarcinoma of the lung.
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figure3
A biopsy of the lung tumour was performed by bronchoscopy, and the specimen revealed adenocarcinoma of the lung (Figure 3), with a polymerase chain reaction-invader assay showing a negative EGFR mutation status.
Colonoscopic examination images. (a) A submucosal tumour with ulceration was seen in the sigmoid colon. (b) Two months after the diagnosis, the tumour had disappeared and a longitudinal ulcer was seen. (c) Close-up observation revealed pus-like discharge from the ulcer, suggesting tumour-bowel fistulisation.
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figure4
Colonoscopic examination revealed a submucosal tumour in the sigmoid colon, which had ulceration on its top (Figure 4a). Colonoscopic examination showed that a submucosal tumour had disappeared, and a longitudinal ulcer was seen instead (Figure 4b). Close-up observation revealed a pus-like discharge from the ulcer (Figure 4c), suggesting tumour regression following fistulisation into the bowel lumen.
Histological examinations of the sigmoid colon tumour. (a and b) Atypical cells with a high nuclear-cytoplasmic ratio and fine nuclear chromatins (haematoxylin and eosin staining, a: x10, b: x20). (c) The cells were positive for thyroid transcription factor-1 and (d) cytokeratin 7, but were negative for (e) cytokeratin 20 (c-e: x20). Consequently, a diagnosis of metastasis of pulmonary adenocarcinoma to the sigmoid colon was made.
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figure5
Biopsy samples taken from the colonic tumour showed a proliferation of atypical cells with a high nuclear-cytoplasmic ratio and fine nuclear chromatins (Figure 5).