Multiple small intestinal metastatic tumours: from basics to advanced testing

We report the case of a patient with 13 metastatic small bowel tumours presenting with upper gastrointestinal bleeding. He had a video-assisted thoracoscopic left upper lobectomy a year previously for a lung adenocarcinoma. Histological findings of the resected small bowel confirmed a poorly differentiated anaplastic adenocarcinoma (pT3 N1 Mx). Molecular testing on the tumour showed that it harboured KRAS c.182A > T (p.Gln61Leu) mutation, which was similar to the mutation reported on the primary lung adenocarcinoma. Based on this he received adjuvant chemotherapy and immunotherapy (carboplatin, pemetrexed and pembrolizumab) and a CT scan performed two months after the small bowel resection demonstrated no evidence of tumour recurrence. He, however, developed chemotherapy-related nausea and vomiting, and with further deterioration was placed on a palliative care pathway and died 3 months after the bowel resection. This case highlights the role of integrating histopathology, immunohistochemistry, and molecular genetics in distinguishing metastatic from primary small intestinal adenocarcinomas.