A 71-year-old male smoker with a clinical history of the presence of a fibrotic pseudonodule in the upper lobe of the right lung, whose follow-up included repeated biopsies that showed no signs of malignancy.
The clinical picture described begins when the patient comes to the emergency department and requires hospitalization due to the appearance of abdominal colic pain, associated with progressive cessation in the emission of feces and gases.
Physical examination revealed a tympanic abdomen with increased peristalsis.
The initial radiological study showed dilation of small bowel loops, and days later it was possible to add contrast which showed the existence of jejunal stenosis.
CT scan showed no abdominal masses or changes in the pulmonary pseudonodule.
An abdominal laparotomy was performed, identifying an obstructive jejunal tumor of 3 cm, which was completely resected.
The anatomopathological study of the piece described the unusual presentation of the small intestine wall due to a poorly differentiated carcinoma.
Immunohistological staining was positive for cytokeratin 7, TTF-1, AE-1/AE-3, and negative for cytokeratin 20.
1.
PET showed pathological uptake in the upper lobe of the right lung and mediastinal nodulations.
The patient, who was duly informed, refused the re-launch of a lung biopsy and mediastinoscopy, and was then treated for his condition.
Three months later, a new hospital admission was necessary due to progressive dysphagia and headache.
Upper gastrointestinal endoscopy revealed esophageal stricture due to extra intestinal compression that could not be sealed with the endoscope. A surgical gastrostomy was performed to maintain adequate enteral nutrition.
Chest CT demonstrated the growth of the pulmonary nodule and mediastinal lymph nodes, with involvement of the esophageal lumen.
A cranial CT scan showed multiple brain metastases.
At this point the possibility of receiving treatment was once again proposed to the patient, finally counting with its acceptance.
The therapy administered at the lower unit consisted of holocranic irradiation (30 Gy) and six cycles of chemotherapy (carboplatin + paclitaxel), with an assessment at the end of the same 20% tumor size (1) stable tumor according to criteria.
Finally, the patient died two months later due to dissemination in the form of meningeal carcinomatosis.
Necropsy confirmed the diagnosis of poorly differentiated carcinoma of the brain, over scar in the right upper lobe (car cancer), with equal immunohistochemical markers to those found in the intestinal tumor, mediastinum, lymph node, colon, trachea.
