Small intestinal metastases from esophageal carcinoma presenting as a perforation: A case report and review of the literature

Small Bowel Obstruction Caused by Small Intestinal Metastasis Secondary to Esophageal Carcinoma

Despite the frequent rapid spread of esophageal cancers to other organs, metastases to the small intestine are uncommon. As such, this paper describes a case of a 60-year-old male who developed a small intestinal obstruction due to metastasis from esophageal carcinoma. This patient had received radical esophagectomy for esophageal carcinoma 14 months prior to the diagnosis. Furthermore, the important role of computed tomography scans played in composing the differential diagnosis will be explored. In order to relieve the obstruction, resection of the small intestine was performed, and the patient survived six months postoperatively.

Malignant degeneration of mature cystic teratoma of the ovary with small bowel metastasis incidental serous cystadenoma collision tumor of the right ovary

Mature Cystic Ovarian Teratoma (MCOTs) are the most common benign ovarian neoplasms, representing around 20% of all ovarian neoplasms with middle age women representing the majority of patients. They usually include two germ cell layers being well differentiated and rarely they demonstrate malignant transformation with squamous cell carcinoma being the most common malignant transformation. In our case, we report an interesting case of a 45 years old lady who was unfortunate to have a MCOT with malignant degeneration and distant metastasis. We concluded that MCOT malignant degeneration is rare, however, if not caught early, mortality can be high.

MCOT, Ovary, Small Bowel, Teratoma, Collision tumor

Presentation of gastroesophageal junction adenocarcinoma with synchronous metastases at the small intestine. Could treatment with curative intent be considered? A case report

Introduction

Introduction of multimodality treatment as the standard of care for management of esophageal and gastroesophageal junction (GEJ) cancer over the last years has led to significant improvement in survival for patients with localized disease. Nevertheless, treatment with curative intent is not considered in the case of metastatic disease. We report a case of a locally advanced GEJ adenocarcinoma with solitary resectable synchronous metastases at the jejunum and a good response to neoadjuvant therapy followed by esophagectomy with curative intention.

Case presentation

This is the case of a patient with poorly differentiated adenocarcinoma of the GEJ with synchronous metastases at the jejunum. The patient underwent extensive work-up including PET-CT. The metastases at the jejunum were completely resected during an initial staging laparoscopy and there was no evidence of further metastatic disease. The patient received chemotherapy and re-staging showed remarkable tumor response. Esophagectomy with curative intent was performed. Histopathology showed complete pathologic response after chemotherapy. Although our patient had a stage IV disease at presentation, he remained metastasis-free for a significant period of time, with no evidence of any distant recurrence during a follow-up of 16 months after esophagectomy.

Discussion and conclusions

Synchronous metastasis to the small bowel from an esophageal carcinoma is a rare entity. Routine PET-CT in addition to conventional CT may assist in more precise staging of a patient with resectable disease. Stage IV esophageal cancer with limited and resectable metastatic disease and good tumor response to oncological therapy may be considered for treatment with potentially curative intent.

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Synchronous metastasis to the small bowel from an esophageal carcinoma is a rare entity.

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PET-CT in addition to conventional CT may assist in more precise staging of esophageal cancer.

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Esophageal cancer with resectable metastases may be considered for treatment with curative intent.

A rare cause of small bowel perforation: A metastatic lesion from squamous cell carcinoma of the tongue

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Metastasis from head and neck tumors to the gastrointestinal tract is rare.

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The mechanism of metastasis in those cases is unclear due to the rarity.

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Based on the existing data, prognosis is dismal in such cases.

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Perforation of the bowel can happen either spontaneously due to tumor erosion of the wall, or it can be induced by chemotherapy.

Background

Metastatic lesions from head and neck tumours to the small bowel are extremely rare, and metastasis from tongue squamous cell carcinoma in particular has been reported only twice in the English literature.

Case presentation

A 76 year-old lady diagnosed with a loco-regionally advanced tongue squamous cell carcinoma but deferred surgical resection. Seven months later after her diagnosis, she presented with generalized abdominal pain, due to image-proven viscous perforation, thus taken for emergent exploratory laparotomy, where the perforation was found at the distal ileum, which was resected, and a primary side to side anastomosis was done. The histopathological examination of the resected segment revealed squamous cell carcinoma originating from the tongue. The patient was deteriorating clinically and vitally during her stay, and passed away on day 16 post operation due to multi-organ dysfunction syndrome.

Conclusion

Metastatic lesions from tongue carcinoma found in the vicinity of the small bowel represent a terminal stage with a dismal prognosis, and when these lesions present clinically with a complicated course, the survival rate is decreased significantly.