Clinics and Research in Hepatology and Gastroenterology (2013) 37, e143—e144
Available online at www.sciencedirect.com
CASE REPORT
Synchronous perianal metastasis of lung adenocarcinoma: Report of a case Marine Camus a,∗, Vincent de Parades a,b, Jean-Franc ¸ois Fléjou c, Patrick Atienza a, Jean-David Zeitoun a,d a
Department of Proctology, Diaconesses Hospital, 18, rue du Sergent-Bauchat, 75012 Paris, France Department of Gastroenterology, European Georges-Pompidou Hospital, AP—HP, Paris, France c Department of Pathology, Saint-Antoine Hospital, AP—HP, Paris, France d Department of Gastroenterology, Saint-Antoine Hospital, AP—HP, Paris, France b
Available online 5 September 2012
A 53-year-old woman was referred to our proctology unit for non-healing perianal ulceration. Her medical history was significant for active smoking since she was 18. She had been treated for three months by her primary care physician with antibiotics and local ointments. Physical examination showed a perianal ulceration which was highly suspicious of malignancy (Fig. 1). Exploration under anaesthesia did not find any suspicious lesion in the anal canal or the lower rectum and a biopsy was made. Histopathological analysis was in favour of a moderately differentiated adenocarcinoma, with clear cells. The immunohistochemistry profile revealed a primary lung cancer: high expression of TTF1 and cytokeratin K7, without cytokeratin K20 (Fig. 2). Computed tomography scan was performed, showing a pulmonary mass of the left lung, which was assumed to be the primary cancer. She also had multiple sus- and sub-diaphragmatic lymphadenopathies, as well as liver and subcutaneous metastasis. She is currently treated with cisplatin and pemetrexed.
∗
Corresponding author. E-mail address:
[email protected] (M. Camus).
Figure 1 cinoma.
Perianal metastatic ulceration from lung adenocar-
We report here a rare case of a perianal metastasis from a lung adenocarcinoma, presenting as a perianal ulceration strongly mimicking primary anal cancer. Very few cases have
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e144
M. Camus et al. reported anal metastasis from lung cancer [1,2], most often from squamous cell carcinoma [3] but extremely rarely from adenocarcinoma proved by immunohistochemistry (TTF1+, CK 7+, CK 20−) [4]. The differential diagnosis of this lesion could have been a primary lesion as an adenocarcinoma arising a fistula in Crohn’s disease or an anal gland adenocarcinoma and less likely, it could have been a metastasis from another location. In fact, several cases of anal metastasis from colorectal, breast, kidney and pancreatic cancers have already been published [5]. This case illustrates the usefulness of immunohistochemistry in the final diagnosis. Surgical caution is essential. Indeed, it is preferable to perform biopsie(s) instead of a large resection of a suspicious lesion, especially because radiotherapy and (or) chemotherapy are likely to be the preferred therapeutic approaches. In conclusion, the anal margin should be considered as the possible site of lung’s metastasis and more broadly to any secondary malignant tumour, even in case of adenocarcinoma.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
References
Figure 2 Histological analysis of the anal margin lesion. a: hematoxylin eosin saffron stains (HES); b: immunohistochemistry TTF1+.
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