Small bowel metastasis from large cell carcinoma of the lung: Report of two cases

Background: Prognosis of patients with lung cancer developing small bowel metastasis, a rare event, is generally believed extremely poor, but it could be improved by early diagnosis and appropriate treatment. We report two cases with small bowel metastasis with different prognoses. Cases: Case 1: A 72-year-old man, who had undergone right upper lobectomy seven months previously because of large cell carcinoma of the lung, visited us complaining of abdominal fullness. A huge mass in the small bowel was detected with computed tomography scans of the abdomen, and it was immediately resected. The pathologic diagnosis was metastasis of large cell carcinoma to the jejunum. After receiving adjuvant chemotherapy, the patient has survived for 3 years. Case 2: A 51-year-old man, receiving whole brain irradiation and salvage chemotherapy for brain relapse of large cell carcinoma of the lung after surgical resection, suddenly complained of severe abdominal pain. A chest radiograph revealed free air under the diaphragm. He underwent an emergency laparotomy and resection of the perforated jejunum with perforation. The pathologic diagnosis of the resected specimen was metastasis of large cell carcinoma to the jejunum. He died of brain metastasis one month after surgery. Conclusion: These cases indicate that the prognosis of patients with lung cancer developing small bowel metastasis can be improved by early detection and intensive treatment of this complication.