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Panel A: Colonoscopy revealed a bowel hemorrhage from the colorectal carcinoma. Panel B: Hematoxylin-eosin stain showed well-to-moderately differentiated tubular adenocarcinoma. (x200).
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Following his recovery from the acute cardiac insufficiency, he suffered from a sudden bowel hemorrhaged due to colorectal carcinoma (Fig. 1).
Panel A: Chest X-ray revealed the right tumor and the infiltration shadows around the tumor. Panel B, and C and D: Chest CT revealed a pulmonary tumor(C and D; red arrows), hilar (D; yellow arrowheads) and mediastinal (B and C; red arrowheads) lymphadenopathy is enhanced by contrast medium.
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After recovery from the heart failure and bowel hemorrhage, chest CT revealed that the size of the pulmonary tumor had increased in size to 10.4 cm (Fig. 2).
Panel A: Bronchoscopy revealed the tumor in the segmental bronchus B5 of the right middle lobe. There was no finding of hemorrhage from the pulmonary tumor. Panel B: Hematoxylin-eosin stain shows poorly differentiated adenocarcinoma (x200). Panel C and D: Immunohistological staining showed that both TTF-1 (C) and CK20 (D) are negative in the pulmonary tissue sample (x200).
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A tissue biopsy of the pulmonary tumor was performed via bronchoscopy (Fig. 3A). The histological diagnosis was poorly differentiated adenocarcinoma (Fig. 3B). We could not make a differential diagnosis between primary lung carcinoma and metastatic lung tumor from colorectal carcinoma because both TTF-1 and CK20 were immunohistologically negative (Fig. 3C and D).