A Case of Primary Lung Cancer Detected by Perforated Peritonitis Associated with a Small Intestinal Metastasis

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  • 小腸転移による穿孔性腹膜炎を契機に発見された原発性肺癌の1症例
  • ショウチョウ テンイ ニ ヨル センコウセイ フクマクエン オ ケイキ ニ ハッケン サレタ ゲンパツセイ ハイガン ノ 1 ショウレイ

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Abstract

<p>A 67-year-old man presented to our hospital with the complaints of abdominal pain and melena. He was diagnosed as having gastrointestinal perforation and emergency surgery was performed. A perforating tumor was found in the jejunum; therefore, resection of the affected segment of the small intestine was performed. Histopathological examination of the resected tumor revealed undifferentiated cancer. Postoperative computed tomography revealed a 40-mm tumor in the upper lobe of the left lung. Moreover, histopathological examination of a biopsy specimen revealed that it was an undifferentiated cancer with identical characteristics to those of the small intestinal tumor. The patient was diagnosed as having primary lung cancer and intestinal metastasis. Furthermore, metastases were also found in the right supraclavicular lymph nodes, duodenum, and right adrenal gland; thus, the patient was diagnosed as having lung cancer, cT2aN3M1c, Stage Ⅳ. The postoperative course of the patient was uneventful and he was discharged on postoperative day 28. The patient responded well to pembrolizumab therapy and has done well until now, 2 years and 8 months since the surgery. Perforation associated with a small intestinal metastasis from lung cancer would be expected to carry a poor prognosis. However, early drug therapy may lead to a good long-term outcome, especially in previously untreated cases of lung cancer, depending on the clinical course and histopathological findings.</p>

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