Symptomatic duodenal metastasis from a small cell lung cancer primary: a rare case

An elderly man presented with chest pain and shortness of breath on a background of left lower lobe small cell lung cancer, previously treated with chemotherapy. Blood test showed iron deficiency anaemia requiring transfusion. An oesophagogastroduodenoscopy was performed, highlighting an external compression to the distal stomach and a 15 mm round lesion, with a central ulcerated depression and rolled edges in D3, which was suspicious of malignancy (figure 1). Target biopsies (figure 2) confirmed the malignant nature of the lesion with features of small cell neuroendocrine carcinoma, in keeping with a lung metastasis. Gastrointestinal metastases from a lung cancer primary are rare, with a clinical prevalence of 0.19%. The small bowel is the most common gastrointestinal metastatic site and tumours are spread via the haematogenous and lymphatic routes. Patients with small bowel involvement usually present with bowel perforation or gastrointestinal bleeding. Diagnosis is made through oesophagogastroduodenoscopy or emergency laparotomy and the average time between discovery of gastrointestinal metastasis to death is 3–4 months. Panagiotis Armonis , Jeffrey Leung, Charles Murray, Alberto Murino General Internal Medicine, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK Division of Surgery and Interventional Science, UCL, London, UK Gastroenterology, Royal Free Hospital, London, UK Royal Free Unit for Endoscopy, Royal Free Hospital Liver Services, London, UK