PMC9941851_01
Pathological findings of the lung primary tumor and the small intestinal metastatic tumor. a Hematoxylin-eosin staining of the lung squamous cell carcinoma. b Immunohistochemical analysis indicated the lung squamous cell carcinoma was positive for P40. c Hematoxylin-eosin staining of the small intestine metastatic tumor cells. d Immunohistochemical analysis indicated the small intestine metastatic tumor cells were positive for CK5/6.
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F1
Postoperative pathological analyses revealed a keratinized squamous cell carcinoma of the left lower lung with vascular invasion (+), nerve invasion (+), p40 (+), and lymph node metastasis (1/9) (Fig. 1a, b). Postoperative immunohistochemical analyses revealed the small intestinal tumor cells to be positive for p40 and CK5/6, but negative for cytokeratin 7 (CK7), CK20, and thyroid transcription factor-1 (TTF-1) (Fig. 1c, d), consistent with a metastatic squamous cell carcinoma, potentially of pulmonary origin.
CT findings of the small intestinal metastatic tumor. a Local thickening of the small intestine wall at the pelvic entrance level was about 1.3 cm, and the lesion length was about 5.7 cm b Multiple lymph nodes can be seen at the mesentery root, and the larger ones are about 2.7x2.3 cm in size. c Anastomosis was significantly thickened with mass formation, and the size of the mass was about 3.0x3.2 cm in size. d On the left side of the pelvic cavity, there was another mass above the bladder, about 2.8x3.2 cm in size.
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F2
Abdominal enhanced CT imaging revealed local thickening of the wall of the small intestine together with mesenteric lymph node enlargement potentially consistent with lymphoma or primary tumor metastasis (Fig. 2a, b). At 3 months post-surgery, abdominal enhanced CT reexamination revealed significant thickening of the small intestinal anastomosis and mass formation, together with an additional mass on the left side of the pelvic cavity above the bladder suggestive of postoperative tumor recurrence (Fig. 2c, d).
SBCE findings of the small intestinal metastatic tumor. An irregular mass in the distal ileum, involving 1/2 circle (a), with rough surface (b), ulceration, and active bleeding (c).
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F3
The patient was considered to exhibit a low risk of capsule retention such that a capsule endoscopy was performed which revealed an irregular mass in the distal ileum occupying half of the lumen with a rough, ulcerated surface that was actively bleeding (Fig. 3).