An unusual case of isolated peritoneal metastases from lung adenocarcinoma

Our plain-English summary of An unusual case of isolated peritoneal metastases from lung adenocarcinoma, by A. Bazine, M. Fetohi, M.R. Khmamouch, et al (Case Reports in Oncology, 2014).

The study

• Authors: A. Bazine, M. Fetohi, M.R. Khmamouch, T. Namad, M. Ichou, H. Errihani
• Journal: Case Reports in Oncology
• Published: 2014;7(2):600-4
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Peritoneal metastases from lung cancer are a rare event. In this paper, we report the case of a patient with adenocarcinoma of the lungs who had isolated peritoneal metastases at the time of diagnosis.

Case Report: We report a 55-year-old female who presented with shortness of breath, decreased effort tolerance, cough, and weight loss. Her initial chest X-ray and subsequent chest CT showed a 12 × 9 × 8 cm mass in the middle lobe of the right lung. The histopathological examination of her biopsy material was consistent with a thyroid transcription factor-1 positive lung adenocarcinoma. In the abdomen, a 5.3-cm mass was identified. A biopsy and immunohistochemistry revealed a lung adenocarcinoma. The patient was administered chemotherapy based on carboplatin-paclitaxel-bevacizumab, but only with a partial response. Six months later, the patient showed brain metastases. Therefore, a second-line treatment based on pemetrexed was administered for 9 courses, and a clinical and radiological response was observed. The chemotherapy was stopped and the patient did not exhibit any symptoms of progression while waiting for a new evaluation.

Discussion: The incidence of peritoneal involvement of lung cancer without metastases in other parts of the body is scarcely encountered in clinical practice. Out of the different types of lung cancers, adenocarcinoma and large cell carcinoma are most likely to metastasize in the peritoneum. Immunohistochemical staining patterns were important in the differential diagnosis with the other etiologies for peritoneal metastasis and the mesothelioma. Peritoneal metastases are indicative of a disseminated disease and prognosis is extremely poor.

In plain English

This article was a case report about one patient: a 55-year-old woman described by doctors at hospitals in Morocco. She had shortness of breath, cough and weight loss, and had never smoked. A chest CT showed a 12 by 9 by 8 cm mass in the middle lobe of the right lung, and a biopsy showed lung adenocarcinoma. A bone scan and head CT found no spread to distant organs, but a 5.3 cm mass was seen in the abdomen. Surgery found several small nodules in the omentum and peritoneum, the largest 0.5 cm across. Their staining pattern matched the lung cancer. She was treated with carboplatin, paclitaxel and bevacizumab and had a partial response. Six months after treatment, cancer appeared in the brain. She was treated with brain radiotherapy and then nine courses of pemetrexed, after which a clinical and radiological response was seen. The authors concluded the case was unusual because the cancer had spread only to the peritoneum. The article does not mention asbestos. Mesothelioma came up only as a diagnosis to rule out by tissue staining.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 55-year-old woman who had never smoked, treated by authors from military hospitals in Meknes and Rabat and the National Institute of Oncology of Rabat, Morocco; dates of care not given
• Exposure: No asbestos or other occupational exposure is described; the article reports only that the patient had never smoked or abused alcohol
• Main results:
  • Chest CT showed a 12 by 9 by 8 cm mass in the middle lobe of the right lung; biopsy was consistent with TTF-1 positive lung adenocarcinoma
  • No EGFR-activating mutations or EML4-ALK translocations were found in the lung tumor
  • Bone scintigraphy and cranial CT found no distant organ metastases; a 5.3 cm abdominal mass was identified
  • Exploratory laparotomy found several nodules in the greater omentum and peritoneum, the largest 0.5 cm; omental biopsy showed adenocarcinoma
  • The peritoneal tumor stained positive for TTF-1 and CK7 and negative for CK20, matching the primary lung cancer
  • After 6 courses of carboplatin, paclitaxel and bevacizumab, a partial response was obtained and bevacizumab maintenance was started
  • Six months after treatment, brain metastases appeared and were treated with 30 Gy of palliative whole-brain radiotherapy
  • After 9 courses of second-line pemetrexed, a clinical and radiological response was observed; at the time of writing she was off chemotherapy with no symptoms of progression
• The authors' conclusion: The authors concluded the case was unusual because the patient developed isolated peritoneal involvement without distant metastases, and that imaging followed by biopsy and immunohistochemistry are the best tools for confirming the primary lung cancer diagnosis

Topics

Medical terms in this study, explained in our Lexicon: Lung Adenocarcinoma, Lung Cancer, Adenocarcinoma, Chest X-Ray, Biopsy, Thyroid Transcription Factor-1 (TTF-1), Immunohistochemistry, Chemotherapy.

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