Background: The incidence of gastrointestinal metastasis of lung cancers is low. However, if present the involvement is predominantly found in the esophagus, stomach, and small intestine. Clinical symptoms comprise of perforation, obstruction, or bleeding. Patient: We report on a 68-year-old male patient in whom a cytological diagnosis of adenocarcinoma of the lung with mediastinal lymph node metastasis was made in September 1993. After receiving radiation treatment to the chest, the patient developed further metastasis to the brain, liver, and bone. Radiotherapy to the brain (60 Gy) was applied with complete cerebral response. In April 1994 he complained of intermittent hematochezia, colonoscopy revealed a cecal tumor 5 cm in diameter. The histologic examination revealed a small-cell carcinoma consistent with a metastatic lesion. The original tumor was reclassified as combined small-cell cancer of the lung. Chemotherapy was initiated leading to a partial remission lasting for 6 months. Conclusion: The recognition of a symptomatic large-bowel tumor as a small-cell carcinoma led to reevaluation of primarily diagnosed adenocarcinoma of the lung now classified as a combined small-cell lung cancer. This widened diagnosis led to new chemotherapeutic options in an advanced disease situation with impressive clinical benefit and a partial remission for 6 months. Thus, histologic or cytologic analysis of metastatic lesions – especially if they are found in an atypical location – may have implications in regard to the primary diagnosis and consequently may lead to improved therapeutic strategies.

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