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Oral and gastrointestinal symptomatic metastases as initial presentation of lung cancer
  1. Jenifer Jeba1,
  2. Selvamani Backianathan2,
  3. Gunadala Ishitha3,
  4. Ashish Singh4
  1. 1Palliative Care Unit, Christian Medical College Hospital, Vellore, India
  2. 2Department of Radiotherapy, Christian Medical College Hospital, Vellore, India
  3. 3Department of General Pathology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  4. 4Department of Medical Oncology, Christian Medical College and Hospital, Vellore, India
  1. Correspondence to Dr Selvamani Backianathan, selvamani{at}


Metastasis to the tongue, duodenum or pancreas from primary lung cancer is uncommon. Primary lung cancer presenting with symptoms related to metastases at these sites, at initial presentation is extremely rare. We report a 45-year-old man with disseminated lung malignancy who presented with dyspepsia, melena, symptoms due to anaemia and swelling in the tongue. Oral examination revealed a hard submucosal anterior tongue lesion. Biopsies from the tongue lesion and the duodenal ulcer seen on upper gastrointestinal endoscopy were suggestive of metastasis from lung primary. CT revealed lung primary with disseminated metastasis to lung, liver, adrenals, kidneys, head and body of pancreas, duodenum and intra-abdominal lymph nodes. The patient was treated with palliative chemotherapy. The unusual presentation and diagnostic details are discussed.

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  • Contributors JJ, GI and AS were involved in patient care. JJ and SB wrote the manuscript. GI and AS reviewed the manuscript. GI contributed the pathology photomicrograph.

  • Competing interests None declared.

  • Patient consent Obtained.

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