Successful resection of colonic metastasis of lung cancer after colonic stent placement:A case report and review of the literature

BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive organs,especially the colon,are rare.CASE SUMMARY An 83-year-old man diagnosed with lung cancer received radiation and chemoimmunotherapy,resulting in a complete clinical response.One year after the initial lung cancer diagnosis,the patient presented with obstructive ileus caused by a tumor in the descending colon.An elective left hemicolectomy was successfully performed after the endoscopic placement of a self-expandable metallic stent(SEMS).Pathologically,the tumor of the descending colon was diagnosed as lung cancer metastasis.The postoperative course was uneventful,and the patient is in good condition 13 mo after surgery,with no signs of recurrence.The previous 23 cases of surgical resection of colonic metastasis from lung cancer were reviewed using PubMed to characterize their clinicopathological features and outcomes.CONCLUSION SEMS is useful for obstructive colonic metastasis as a bridge to surgery to avoid emergency operations.

Long-term survival of patients with hepatocellular carcinoma with hepatic,pulmonary,peritoneal and rare colon metastasis:A case report

BACKGROUND Hepatocellular carcinoma(HCC)is a highly malignant cancer that often metastasizes and has a poor prognosis.Gastrointestinal tract metastases are rare,and colon metastases are even rarer.The long-term survival of patients with multiple intrahepatic and extrahepatic metastases,especially to the colon,has not been previously reported.CASE SUMMARY We present an atypical clinical case of a patient with liver,right lung,peritoneal,and colon metastases diagnosed successively following hepatic resection for primary HCC.Comprehensive treatment,including partial liver,lung and colon resection,palliative management such as systemic chemotherapy,trans-arterial chemoembolization,targeted therapy with sorafenib,and cryotherapy were attempted.Despite his early metastases,the patient remained relatively healthy for 8 years after diagnosis.CONCLUSION This case indicates that comprehensive treatment is beneficial for certain patients with metastatic HCC.Clinicians should be alert as to the possibility of rare site metastatic tumors that may be easily misdiagnosed as primary tumors.

Pancreatic cancer with synchronous liver and colon metastases: A case report

BACKGROUND Metastasis of pancreatic cancer to the colon is rare and the features need to be further elucidated.Herein,we report a rare case of pancreatic cancer with simultaneous liver and colon metastases.CASE SUMMARY A 48-year-old man with intrahepatic space-occupying lesions based on a computed tomography scan was admitted to our hospital for further treatment.Abdominal magnetic resonance imaging revealed a 6.4 cm×4.2 cm mass in the tail of the pancreas and multiple low-density masses in the liver parenchyma.In addition,a mass of 2.2 cm×1.6 cm with surface congestive erosions in the sigmoid colon was detected by colonoscopy.Histopathological examination of biopsies from both the liver and colon lesions revealed a moderately to poorly differentiated adenocarcinoma.Immunohistochemical staining of the colon tumor was positive for cytokeratin(CK)7 and CK,but negative for colorectal adenocarcinoma-related markers CK 20,CDX2,and SATB2,thus indicating that the metastasis originated from the pancreas.Next-generation sequencing for genomic profiling of the liver and colon metastases both found mutations in KRAS(p.G12D)and TP53(c.376-1delG),with microsatellite stable and low tumor mutational burden without actionable or cancer-predisposing gene mutations detected.The patient was subsequently treated with 12 cycles of FOLFIRINOX which led to a sustainable response,followed by ongoing maintenance treatment with irinotecan plus fluorouracil.CONCLUSION For this rare case,careful evaluation of histopathological and immunohistochemical staining results are required.The genomic profiling of colon lesions was revealed for the first time,and FOLFIRINOX showed good treatment efficacy in this patient.

Foxp3 Expression in CD4＋CD25＋Foxp3＋ Regulatory T Cells Promotes Development of Colorectal Cancer by Inhibiting Tumor Immunity

The mechanism underlying CD4~＋CD25~＋Foxp3~＋ regulatory T cells（Tregs） promoting the development of colorectal cancer（CRC） was elucidated in the present study. Forty-eight cases of colorectal carcinomas, 22 cases of colon polyps and 21 cases of normal colorectal tissues were collected. The correlation among Foxp3, IL-10 and Stat3, and the clinical relevance of these three indexes were analyzed. The results showed that the levels of Foxp3 expressed in infiltrating CD4~＋CD25~＋Foxp3~＋Tregs, and IL-10 and Stat3 in CRC tissues were all significantly higher than those in polypus tissues and normal colon tissues（P〈0.01）. Pearson correlation analysis indicated that the expression level of Foxp3 was positively correlated with Stat3 at m RNA level（r=0.526, P=0.036）, and was positively correlated with IL-10 at protein level（r=0.314, P=0.030）. The Foxp3 expressed in CD4~＋CD25~＋Foxp3~＋Tregs was correlated with the histological grade, lymph node metastasis and TNM stage of CRC（P〈0.05 for all）. The IL-10 expression was correlated with the histological grade and TNM stage（both P〈0.05）. The Stat3 expression was correlated with the lymph node metastasis and TNM stage（both P〈0.05）. It was concluded that CD4~＋CD25~＋Foxp3~＋Tregs can inhibit tumor immunity in combination with some other related inhibitory cytokines and that Foxp3 expression in CD4~＋CD25~＋Foxp3~＋Tregs correlates with CRC progression.