PMC3539111_01
(A) Chest computed tomography scan shows high density mass in right upper lobe. (B) Liver magnetic resonance imaging scan shows 1 cm sized nodule in segment 2.
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F1
Six months earlier, he was diagnosed with lung cancer and liver metastasis (Fig. 1A, B).
Abdomen computed tomography scans show liver metastasis with pneumoperitoneum (A) and small bowel edematous change with fluid collection in distal ileum (B).
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F2
CT and it showed pneumoperitoneum and aggravation of hepatic metastasis (Fig. 2A, B). Considering disease status and physical status we decided to do an emergency laparotomy.
Microscopic findings of small bowel. (A) The small bowel mucosa shows infiltration of tumor cells (H&E, x100). (B) The malignant cells show positive stain for cytokeratin 7 (CK7), suggesting not primary colon origin (immunohistochemical [IHC] stain, x100). (C) Negative satin for thyroid transcription factor-1, suggesting lung cancer origin (IHC stain, x100). (D) Negative stain for CK20 (IHC stain, x100).
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F3
Immunohistochemical (IHC) staining revealed that the tumor cells were positive for cytokeratin 7 (CK7) and thyroid transcription factor (TTF) but negative for CK20 (Fig. 3A-D).