Clinical Journal of Gastroenterology

, Volume 9, Issue 4, pp 208–214 | Cite as

Pedunculated-type T1 colorectal carcinoma with lung carcinoma metastasis at the deepest invasive portion

  • Naoki Asayama
  • Shiro OkaEmail author
  • Shinji Tanaka
  • Daiki Hirano
  • Kyoku Sumimoto
  • Yuki Ninomiya
  • Yuzuru Tamaru
  • Kenjiro Shigita
  • Nana Hayashi
  • Fumio Shimamoto
  • Koji Arihiro
  • Kazuaki Chayama
Case Report


We present a rare case of colorectal T1 carcinoma with metastasis of previous lung carcinoma found at the deepest invasive portion. A 61-year-old man presented with cervical lymphadenopathy 18 years after undergoing surgery for right lung carcinoma [poorly differentiated adenocarcinoma stage IIb (T3N0M0)]. Contrast-enhanced computed tomography showed enlarged lymph nodes (LNs) in the neck and mediastinal regions. Combined hybrid-F-fluorodeoxyglucose positron emission-computerized tomography showed increased radionuclide uptake in multiple cervical LNs and mediastinal LNs. LN biopsy revealed a poorly differentiated adenocarcinoma, suspected to be a metastatic tumor of the lung. Subsequent colonoscopy revealed a pedunculated-type lesion with a depressed area in the ascending colon. We performed polypectomy as total excisional biopsy; this tumor was composed mainly of moderately differentiated adenocarcinoma, partially mixed with mucinous adenocarcinoma. The pathological findings of the invasive front of the colorectal carcinoma showed poorly differentiated adenocarcinoma with a morphological pattern similar to that of the previous lung carcinoma. Furthermore, immunohistochemical results for the histological type of the deepest invasive portion of the tissue specimen were positive for thyroid transcription factor-1 but negative for Caudal-type homeobox 2. From these morphological and immunohistochemical findings, the final diagnosis was moderately differentiated lung carcinoma, pTX N3 M1b (LN, colon) Stage IV.


Pedunculated-type T1 colorectal carcinoma Metastasis Lung carcinoma Magnifying colonoscopy 


Compliance with ethical standards

Conflict of interest

Naoki Asayama, Shiro Oka, Shinji Tanaka, Daiki Hirano, Kyoku Sumimoto, Yuki Ninomiya, Yuzuru Tamaru, Kenjiro Shigita, Nana Hayashi, Fumio Shimamoto, Koji Arihiro and Kazuaki Chayama declare that they have no conflict of interest.

Human rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed consent

Informed consent was obtained from all patients included in the study.


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Copyright information

© Japanese Society of Gastroenterology 2016

Authors and Affiliations

  • Naoki Asayama
    • 1
  • Shiro Oka
    • 2
    Email author
  • Shinji Tanaka
    • 2
  • Daiki Hirano
    • 1
  • Kyoku Sumimoto
    • 1
  • Yuki Ninomiya
    • 1
  • Yuzuru Tamaru
    • 1
  • Kenjiro Shigita
    • 1
  • Nana Hayashi
    • 2
  • Fumio Shimamoto
    • 3
  • Koji Arihiro
    • 4
  • Kazuaki Chayama
    • 1
  1. 1.Department of Gastroenterology and Metabolism, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  2. 2.Department of EndoscopyHiroshima University HospitalHiroshimaJapan
  3. 3.Department of Health Science, Faculty of Human Culture and SciencePrefectural University of HiroshimaHiroshimaJapan
  4. 4.Department of Anatomical PathologyHiroshima University HospitalHiroshimaJapan

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