[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-373771-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-373771-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","rectal-metastasis-as-the-initial-presentation-of-primary-lung-adenocarcinoma-with-an-egfr-l858r-mutation-a-case-report","Rectal metastasis as the initial presentation of primary lung adenocarcinoma with an EGFR L858R mutation - a case report","","Non-small cell lung cancer (NSCLC) makes up about 80% of lung cancers, and nearly 40% of patients show distant metastases at diagnosis. Symptomatic rectal metastasis from a primary lung adenocarcinoma before respiratory symptoms is extremely rare. This case report describes an uncommon presentation where a 79-year-old man’s constipation led to detection of rectal metastasis, supported by imaging and immunohistochemistry, with an EGFR L858R mutation guiding targeted therapy.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/rectal-metastasis-as-the-initial-presentation-of-primary-lung-adenocarcinoma-with-an-egfr-l858r-mutation-a-case-report/373771/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/rectal-metastasis-as-the-initial-presentation-of-primary-lung-adenocarcinoma-with-an-egfr-l858r-mutation-a-case-report/373771.png","ImageObject",300,407,{"name":42,"@type":43},"Bulrr","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-04","2026-09-23",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is rectal metastasis from primary lung adenocarcinoma before lung symptoms considered rare?","Question",{"text":63,"@type":64},"The article notes that rectal involvement is relatively uncommon in clinical practice, even though gastrointestinal metastases can be found at autopsy. Symptomatic rectal metastasis occurring before the onset of lung symptoms is described as exceedingly rare.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was the rectal metastasis diagnosed in this case?",{"text":68,"@type":64},"Constipation prompted colonoscopy and imaging. Immunohistochemical staining of rectal biopsy and resected white nodules showed markers consistent with lung adenocarcinoma origin, confirming rectal metastasis.",{"name":70,"@type":61,"acceptedAnswer":71},"How did the EGFR L858R mutation affect treatment?",{"text":72,"@type":64},"After surgery, treatment with aumolertinib mesilate targeted the EGFR L858R mutation, and palliative radiotherapy was used for the rectal metastatic lesion.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},373771,1790744850,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":107,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144},5909892115043,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Nian et al. World Journal of Surgical Oncology (2025) 23:362  \n[https://doi.org/10.1186/s12957-025-04016-5](https://doi.org/10.1186/s12957-025-04016-5)  \nWorld Journal of Surgical Oncology  \nCASE REPORT Open Access  \nRectal metastasis as the initial presentation of primary lung adenocarcinoma with an EGFR L858R mutation: a case report  \nRui Nian 1†, Mengzhu Wang2†, Juanyi Wang3, Xiang Li 1, Jianjun Li3, Ling Lin2, Shushen Ji2, Huihui Jiang2* and Wanjun Li 1*  \nAbstract  \nBackground Non-small cell lung cancer (NSCLC) accounts for approximately 80% of all Lung cancers, and 40% of patients with lung cancer present with distant metastases at diagnosis. Symptomatic rectal metastasis from primary lung adenocarcinoma before the onset of lung symptoms is exceedingly rare. This is the first report to describe an uncommon case of rectal metastasis from an EGFR L858R-mutant primary lung adenocarcinoma.  \nCase presentation A 79-year-old male presented to the hospital for worsening constipation. Colonoscopy revealed a rectal mass, but initial biopsies revealed only chronic rectal mucosal inflammation. The patient received symptomatic treatment to stimulate defecation, but his symptoms of constipation worsened. As symptoms progressed to dyspnoea, cough, expectoration, bilateral lower limb weakness, and poor appetite, imaging revealed a mixed ground-glass nodule with poorly defined margins in the apical segment of the right upper lobe. Imaging also revealed thickening of the rectal wall in the mid-to-lower segments with multiple small perirectal lymph nodes. Immunohistochemical analysis of both the rectal puncture biopsy specimen and the white nodules resected during the laparoscopic peritoneal biopsy consistently revealed CK7 (+), TTF-1 (+), Napsin A (+), CK20 (−), and CDX2 (-) staining, which confirmed rectal metastasis from primary lung adenocarcinoma. After the laparoscopic transverse colostomy was performed, the patient began treatment with aumolertinib mesilate tablets that target the EGFR L858R mutation and received palliative radiotherapy for the rectal metastatic lesion.  \nConclusions Although rectal metastasis harbouring EGFR L858R mutations from primary lung adenocarcinoma is extremely rare, clinicians should have a low threshold for pulmonary low-dose spiral CT. In addition, histopathologic analysis by immunohistochemistry combined with molecular diagnostics is critical for a timely and accurate diagnosis and to distinguish rectal metastases from primary rectal malignancies.  \nKeywords Rectal metastasis, Lung adenocarcinoma, EGFR L858R, Targeted therapy  \n†Rui Nian and Mengzhu Wang contributed equally to this work.  \n*Correspondence:  \nHuihui Jiang [hhjiang16@fudan.edu.cn](hhjiang16@fudan.edu.cn)[ ](hhjiang16@fudan.edu.cn)Wanjun Li[lwjdf163@163.com](lwjdf163@163.com)  \n1Department of Pathology, Affiliated 3201 Hospital of Xi`an Jiaotong, University Health Science Center, Hanzhong, China  \n2Zhangjiang Center for Translational Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd, Shanghai, China  \n3Medical Oncology, Affiliated 3201 Hospital of Xi`an Jiaotong, University Health Science Center, Hanzhong, China  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by sta","cbCaiktDknGkBPlx","https://ap.wps.com/l/cbCaiktDknGkBPlx","pdf",1469994,"English","# Background\n# Case presentation\n# Conclusions","[{\"question\":\"Why is rectal metastasis from primary lung adenocarcinoma before lung symptoms considered rare?\",\"answer\":\"The article notes that rectal involvement is relatively uncommon in clinical practice, even though gastrointestinal metastases can be found at autopsy. Symptomatic rectal metastasis occurring before the onset of lung symptoms is described as exceedingly rare.\"},{\"question\":\"How was the rectal metastasis diagnosed in this case?\",\"answer\":\"Constipation prompted colonoscopy and imaging. Immunohistochemical staining of rectal biopsy and resected white nodules showed markers consistent with lung adenocarcinoma origin, confirming rectal metastasis.\"},{\"question\":\"How did the EGFR L858R mutation affect treatment?\",\"answer\":\"After surgery, treatment with aumolertinib mesilate targeted the EGFR L858R mutation, and palliative radiotherapy was used for the rectal metastatic lesion.\"}]","Rectal metastasis as the initial presentation of primary lung adenocarcinoma with an EGFR L858R mutation - a case report | PDF",1790200407,18]