Endoscopic manifestations and treatment outcomes of asymptomatic gastric metastases from primary lung adenocarcinoma - Report of two cases

Sep 24, 2026

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Metastatic spread of lung adenocarcinoma to the stomach is rare and is typically detected at an advanced stage due to symptoms. This report presents two cases of asymptomatic gastric metastases showing diminutive nodules or erosion on endoscopy. Magnifying endoscopy with blue laser imaging (BLI‑ME) demonstrated common features, including widened intervening areas and extended subepithelial capillary networks, suggesting subepithelial lesion development. Target biopsy and immunohistochemistry confirmed gastric lesions as metastases from lung cancer; systemic anticancer therapy led to regression to scars, supporting systemic treatment effectiveness for early lesions.

LanguageEnglish

CategoryHealthcare

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Pages6

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Introduction

Case reports

Case 1

ONCOLOGY LETTERS 25: 228, 2023 Endoscopic manifestations and treatment outcomes of asymptomatic gastric metastases from primary lung adenocarcinoma: Report of two cases MEILING WANG 1 , WEI ZHANG 1 , CHUNMEI FU2 , JIAN GUAN3 , XIAOGUANG NI4 and FANG YAO4 Departments of 1Endoscopy, 2Oncology and 3Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116; 4Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, P.R. China Received November 2, 2022; Accepted March 16, 2023 DOI: 10. 3892/ol.2023.13814 Abstract. Metastatic spread of lung adenocarcinoma to the stomach is rare and most gastric metastases are discovered at the advanced stage due to certain symptoms. The present study reported two cases of asymptomatic gastric metas‑ tases from lung adenocarcinoma presenting as diminutive nodules or erosion endoscopically. The manifestations were also visualized under magnifying endoscopy with blue laser imaging (BLI‑ME), the two cases share certain common characteristics under BLI‑ME, such as an obviously widened intervening part and extended subepithelial capillary network, which indicated that lesions developed beneath the superficial epithelium. Target biopsy and further immunohistochemical staining confirmed that the gastric lesions were metastatic from primary lung cancer. None of the two patients were candidates for surgery due to multiple distant metastases, but the gastric metastases regressed to scars after systemic anticancer therapy. These two cases were presented in order to improve the current understanding of the endoscopic mani‑ festations of early gastric metastases from lung cancer, and the outcomes may demonstrate that systemic treatment is effective for eliminating early gastric metastatic lesions. Correspondence to: Professor Fang Yao and Professor Xiaoguang Ni, Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 117 Panjiayuan Nanli, Chaoyang, Beijing 100020, P.R. China E‑mail: [yaofang99@sina.com](yaofang99@sina.com) [Email: nixiaoguang@126.com](Email: nixiaoguang@126.com) Key words: gastric metastasis, lung adenocarcinoma, magnifying endoscopy, case report Introduction Lung cancer is one of the most common malignancies world‑ wide and its incidence and mortality rate are both the highest among cancers in China (1). Approximately half of all patients with lung cancer suffer from metastatic disease at the time of diagnosis, with the most common metastatic regions being lymph nodes, liver, adrenal gland, bone and brain (2). However, gastric metastasis is uncommon with a prevalence of 0.1‑6.8% according to clinical and autoptic results (3‑5) . In most cases, gastric metastases are discovered at an advanced stage when patients experience symptoms, such as abdominal pain, anemia or vomiting, due to perforation, bleeding or obstruc‑ tion caused by the metastatic mass (6,7), which usually predict poor prognosis; the average time between discovery of gastro‑ intestinal metastasis and death ranges from 96.5 to 130.3 days, as reported in certain case series (8,9) . Asymptomatic and diminutive gastric metastases are rarely found in the clinic and the manifestations of gastric metastases from lung cancer under chromoendoscopy and magnifying endoscopy have not been reported in the literature, to the best of our knowledge; furthermore, although there are certain reports regarding the systemic treatment outcome of primary lung cancer with gastric metastasis, which mainly focus on the therapeutic effect of primary tumor treatment (10,11), the effect of systemic treatment on gastric metastatic lesi

FAQs

What endoscopic appearance did the asymptomatic gastric metastases show?

They appeared as diminutive nodules or as erosion on endoscopy.

What did magnifying endoscopy with blue laser imaging (BLI‑ME) reveal?

BLI‑ME showed common characteristics, including an obviously widened intervening part and an extended subepithelial capillary network, indicating development beneath the superficial epithelium.

How were treatment outcomes assessed and what was the result after systemic therapy?

Biopsy and immunohistochemical staining confirmed metastatic origin. Both gastric metastases regressed to scars after systemic anticancer therapy, while surgery was not an option due to multiple distant metastases.

Sep 24, 2026

Uploaded by Theodore