Miura T, Shimaoka Y, Nakamura J, Yamada S, Miura T, Yanagi M, Sato K, Usuda H, Emura I, Takahashi T. TTF-1 is useful for primary site determination in duodenal metastasis. World J Gastrointest Oncol 2010; 2(9): 360-363 [PMID: 21160807 DOI: 10.4251/wjgo.v2.i9.360]
Corresponding Author of This Article
Tomofumi Miura, MD, Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, 2-297-1, Senshu, Nagaoka, Niigata, Japan. miuratom@nagaoka.jrc.or.jp
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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Tomofumi Miura, Junichiro Nakamura, Satoshi Yamada, Tsutomu Miura, Masahiko Yanagi, Toru Takahashi, Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, 2-297-1, Senshu, Nagaoka, Niigata, Japan
Yuichi Shimaoka, Kazuhiro Sato, Division of Respiratory Medicine, Nagaoka Red Cross Hospital, 2-297-1, Senshu, Nagaoka, Niigata, Japan
Hiroyuki Usuda, Division of Medical Technology, Nagaoka Red Cross Hospital, 2-297-1, Senshu, Nagaoka, Niigata, Japan
Iwao Emura, Division of Pathology, Nagaoka Red Cross Hospital, 2-297-1, Senshu, Nagaoka, Niigata, Japan
Author contributions: Miura T, Nakamura J, Yamada S, Miura T, Yanagi M and Takahashi T wrote the paper; Shimaoka Y and Sato K gave chemotherapy to the patient; Usuda H and Emura I engaged in the pathological examination of the patient.
Correspondence to: Tomofumi Miura, MD, Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, 2-297-1, Senshu, Nagaoka, Niigata, Japan. miuratom@nagaoka.jrc.or.jp
Telephone: +81-258-283600 Fax: +81-258-289000
Received: November 14, 2009 Revised: March 5, 2010 Accepted: March 12, 2010 Published online: September 15, 2010
Abstract
We report here on a case of duodenal metastasis from primary lung adenocarcinoma. A 69-year old man was diagnosed with primary lung adenocarcinoma. Four courses of combined chemotherapy with carboplatin and paclitaxel associated with irradiation of 60 Gy shrunk the lung tumor. However, soon after,the para-aortic lymph node became swollen. Esophagogastroduodenoscopy revealed three duodenal tumors. Differential diagnosis between malignant lymphoma and metastatic duodenal cancer was endoscopically difficult. The histology of biopsied specimens was poorly differentiated adenocarcinoma. Immunohistochemical analysis revealed a positive reaction for thyroid transcription factor-1 (TTF-1). Thus, we concluded that these were metastatic duodenal tumors from lung adenocarcinoma. Two courses of gemcitabine led to a complete remission in this duodenal metastasis and para-aortic lymph node swelling with only scarring remaining in computed tomography. He is now on the continuous generalized chemotherapy. In conclusion, duodenal metastasis from primary lung adenocarcinoma is rare and hard to diagnose. In such an instance, TTF-1 immunostaining is crucial to obtain the correct diagnosis.
