Tumor-to-tumor metastasis from lung cancer: a clinicopathological postmortem study

• Published in: Virchows Archiv : an international journal of pathology Vol. 463; no. 4; pp. 525 - 534
• Main Authors: Matsukuma, Susumu, Kono, Takako, Takeo, Hiroaki, Hamakawa, Yusuke, Sato, Kimiya
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2013; Springer Nature B.V
• Subjects: Adrenal Cortex Neoplasms - pathology; Adrenocortical Adenoma - pathology; Aged; Aged, 80 and over; Autopsy; Biomarkers, Tumor - analysis; Carcinoma - pathology; Carcinoma - secondary; Carcinoma, Papillary; Colorectal carcinoma; Female; Humans; Immunohistochemistry; Kidney Neoplasms - pathology; Lung cancer; Lung Neoplasms - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Metastasis - pathology; Neoplasms, Multiple Primary - pathology; Original Article; Pancreatic Neoplasms - pathology; Pathology; Thyroid; Thyroid Cancer, Papillary; Thyroid Neoplasms - pathology; Tumors; Immunohistochemistry; Tumor-to-tumor metastasis; Renal cell carcinoma; Lung cancer; Multiple lung cancers; Endocrine microadenoma; Cancer-to-cancer metastasis
• ISSN: 0945-6317; 1432-2307
• DOI: 10.1007/s00428-013-1455-8

This study examined 47 cases of lung cancer concomitant with other tumors and found eight cases (17 %) with nine foci of tumor-to-tumor metastasis, defined as metastasis of lung cancer into another tumor. Donor lung cancers were four adenocarcinomas, two squamous cell carcinomas, and two small cell carcinomas. Tumor-to-tumor metastasis was found in five of six renal cell carcinomas (83 %), one of eight thyroid papillary carcinomas (13 %), one of three adrenocortical adenomas (33 %), one of three pancreatic endocrine microadenomas (33 %), and another lung cancer (one of six cases of multiple lung cancers, 17 %). The higher recipient incidence in renal cell carcinoma was statistically significant compared with prostatic carcinoma (0/16,
P
 < 0.001), colorectal carcinoma (0/7,
P
 = 0.005), and gastric carcinoma (0/5,
P
 = 0.015). Generalized metastases were found in 88 % of the tumor-to-tumor metastasis cases. The total clinical course of patients with tumor-to-tumor metastasis was shorter than that of the patients without tumor-to-tumor metastasis (mean, 5.4 versus 18.8 months;
P
 = 0.046). Tumor-to-tumor metastasis sometimes mimicked undifferentiated recipient tumor cells. Immunostains for thyroid transcription factor 1 (TTF-1), Napsin A, cytokeratin 7 (CK7), and CK5/6 were useful to confirm tumor-to-tumor metastasis. However, TTF-1-, Napsin A-, and/or CK7-negative lung adenocarcinoma components metastasized to renal cell carcinoma in three cases, and recipient renal cell carcinomas were focally Napsin A+ (two cases) or CK7+ (two cases). Tumor-to-tumor metastasis can occur as a result of metastasis from lung cancer with more aggressive behavior. Tumor-to-tumor metastasis should be carefully distinguished from undifferentiated recipient tumor cells.