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Journal of Clinical Oncology, Vol 24, No 30 (October 20), 2006: pp. 4939-4940 © 2006 American Society of Clinical Oncology. DOI: 10.1200/JCO.2006.06.3354
Lung Cancer Presenting With a Solitary Colon Metastasis Detected on Positron Emission Tomography ScanMultidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
Division of Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
Multidisciplinary Thoracic Oncology Program, Division of Nuclear Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC The patient is a 60-year-old man with a history of tobacco use (80 pack-years) who presented with a history of a cough of several months’ duration, occasionally productive of blood-tinged sputum. As part of the evaluation of these symptoms, a chest x-ray was performed, which revealed hilar fullness. As a result of this finding a computed tomography (CT) scan was performed, which revealed a left upper lobe mass surrounding the left main stem bronchus to the level of the carina, and the pulmonary artery without evidence of mediastinal lymphadenopathy. The patient was evaluated by the thoracic surgery service and determined to be unresectable. A positron emission tomography (PET) -CT scan was performed, which revealed increased [18]fluorine fluorodeoxyglucose (FDG) uptake in the left hilar mass, and focally increased uptake in the ascending colon (Fig 1), and no increased uptake in the mediastinal lymph nodes. The differential diagnosis for the focal area of increased FDG uptake in the colon was abscess, adenomatous polyps, hamartomatous adenoma, colonic primary, and metastatic lesion.1 The patient had a colonoscopy performed 2 years before presentation, which did not reveal any evidence of malignancy. A repeat colonoscopy was performed, which revealed a mass in the ascending colon (Fig 2), and biopsy revealed squamous cell carcinoma consistent with a lung primary. The patient's clinical stage changed from stage III (T4N0M0) to histologic stage IV, and the patient's treatment plan changed from chemoradiotherapy with curative intent to chemotherapy.
In patients with clinical stage III disease, PET scanning will detect extrathoracic metastases in approximately 25% of patients.2-4 Patients who are being considered for surgical resection or chemoradiotherapy with extrathoracic areas of increased FDG uptake detected on PET scan should have a pathologic evaluation of the suspected lesions. A pathologic evaluation of solitary lesions is especially important. A recent retrospective review of patients with non–small-cell lung cancer (NSCLC) found that solitary extrapulmonary lesions were observed on PET-CT imaging in 21% of patients, and 46% of the lesions were either another malignancy, benign tumors, or inflammatory conditions.5 Previously the colon was not considered a frequent site of metastases for NSCLC; however, PET scanning may reveal a higher incidence of colonic metastases than previously suspected. The optimal management of patients with a solitary lesion detected on PET scan is unclear. Data exist that a proportion of patients with solitary brain or adrenal metastasis may experience prolonged survival with resection of both the primary and solitary metastatic lesion.6,7 Whether long-term survival is possible with resection of lung primary and solitary visceral metastasis is not known. Authors' Disclosures of Potential Conflicts of Interest
Although all authors completed the disclosure declaration, the following authors or their immediate family members indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.
Dollar Amount Codes (A) $10,000 (B) $10,000-99,999 (C) $100,000 (N/R) Not Required
REFERENCES
1. Israel O, Yefremov N, Bar-Shalom R, et al: PET/CT detection of unexpected gastrointestinal foci of 18F-FDG uptake: Incidence, localization patterns, and clinical significance. J Nucl Med 46:758-762, 2005 2. Detterbeck FC, Falen S, Rivera MP, et al: Seeking a home for a PET, part 2: Defining the appropriate place for positron emission tomography imaging in the staging of patients with suspected lung cancer. Chest 125:2300-2308, 2004 3. MacManus MP, Hicks RJ, Matthews JP, et al: High rate of detection of unsuspected distant metastases by pet in apparent stage III non-small-cell lung cancer: Implications for radical radiation therapy. Int J Radiat Oncol Biol Phys 50:287-293, 2001[CrossRef][Medline] 4. Eschmann SM, Friedel G, Paulsen F, et al: FDG PET for staging of advanced non-small cell lung cancer prior to neoadjuvant radio-chemotherapy. Eur J Nucl Med Mol Imaging 29:804-808, 2002[CrossRef][Medline] 5. Lardinois D, Weder W, Roudas M, et al: Etiology of solitary extrapulmonary positron emission tomography and computed tomography findings in patients with lung cancer. J Clin Oncol 23:6846-6853, 2005 6. Shahidi H, Kvale PA: Long-term survival following surgical treatment of solitary brain metastasis in non-small cell lung cancer. Chest 109:271-276, 1996 7. Porte H, Siat J, Guibert B, et al: Resection of adrenal metastases from non-small cell lung cancer: A multicenter study. Ann Thorac Surg 71:981-985, 2001
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Copyright © 2006 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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