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Primary lung sarcoma with gastric metastasis and morphological divergence presenting as melena
  1. Michael J Eiswerth1,
  2. Alexander Pinter1,
  3. Samuel Benjamin Reynolds2 and
  4. John Guardiola3
  1. 1Internal Medicine Residency, University of Louisville, Louisville, Kentucky, USA
  2. 2Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
  3. 3Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
  1. Correspondence to Dr Michael J Eiswerth; mjeisw01{at}


A 61-year-old man was admitted to the medical intensive care unit following a 2-week history of weakness, lightheadedness and melena resulting in an acute anaemia. Upper endoscopy revealed multiple large gastric masses without evidence of active bleeding. CT of the chest revealed a large right upper lobe mass with bony destruction of the third rib and invasion into the anterior chest wall and mediastinum, as well as a soft-tissue density in the left kidney. Biopsy and histopathological review of both pulmonary and gastric masses revealed two distinct sarcomatous malignancies that, while both from a primary lung source, differed in their morphology. Natural history and behaviour are not well understood in sarcomas due to their rarity, but abdominal metastasis is considered an uncommon event in the progression of the disease. Gastrointestinal bleeding as the presenting symptom of a primary lung sarcoma is an atypical finding with no previously reported cases.

  • GI bleeding
  • gastroenterology
  • stomach and duodenum
  • oncology
  • lung cancer (oncology)

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  • Contributors As the primary author on this manuscript, I MJE, prepared the majority of the text, performed rough drafts and revisions. I collected all pertinent imaging, created the figures, obtained patient consent, and formatted the citations. As contributing authors, AP, SBR, and JG all read and reviewed the drafts, offered feedbacks and made edits on their own accord. JG was the attending on this case and we took care of the patient during his hospital course. JG also provided me feedback and direction on the direction of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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