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Nomura M, Tei M, Goto T, Hirano M, Nishida K, Mori S, Yoshikawa Y, Tamai K, Hamakawa T, Takiuchi D, Tsujie M, Akamaru Y. Rare recurrence pattern after complete response to chemotherapy in a patient with rectal cancer: a case report. Surg Case Rep 2024; 10:114. [PMID: 38714637 PMCID: PMC11076440 DOI: 10.1186/s40792-024-01913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/26/2024] [Indexed: 05/10/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) often metastasizes to the liver, lungs, lymph nodes, and peritoneum but rarely to the bladder, small intestine, and skin. We here report the rare metastasis of anal cancer in the left bladder wall, followed by metastases to the small intestine and skin, after abdominoperineal resection and left lateral lymph node dissection with chemotherapy in a patient with clinician Stage IVa disease. CASE PRESENTATION A 66-year-old man presented with 1-month history of bloody stool and anal pain and diagnosed with clinical Stage IVa anal cancer with lymph node and liver metastases (cT3, N3 [#263L], M1a [H1]). Systemic chemotherapy led to clinical complete response (CR) for the liver metastasis and clinical near-CR for the primary tumor. Robot-assisted laparoscopic perineal rectal resection and left-sided lymph node dissection were performed. Computed tomography during 18-month postoperative follow-up identified a mass in the left bladder wall, which was biopsied with transurethral resection, was confirmed as recurrent anal cancer by histopathologic evaluation. After two cycles of systemic chemotherapy, partial resection of the small intestine was performed due to bowel obstruction not responding to conservative therapy. The histopathologic evaluation revealed lymphogenous invasion of the muscularis mucosa and subserosa of all sections. Ten months after the first surgery for bowel obstruction and two months before another surgery for obstruction of the small intestine, skin nodules extending from the lower abdomen to the thighs were observed. The histopathologic evaluation of the skin biopsy specimen collected at the time of surgery for small bowel obstructions led to the diagnosis of skin metastasis of anal cancer. Although panitumumab was administered after surgery, the patient died seven months after the diagnosis of skin metastasis. CONCLUSIONS This case illustrates the rare presentation of clinical Stage IVa anal cancer metastasizing to the bladder wall, small intestine, and skin several years after CR to chemotherapy.
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Affiliation(s)
- Masatoshi Nomura
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan.
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Takayoshi Goto
- Department of Pathology, Osaka Rosai Hospital, Sakai, Osaka, 591-8025, Japan
| | - Masataka Hirano
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Kentaro Nishida
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Soichiro Mori
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Yukihiro Yoshikawa
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Koki Tamai
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Takuya Hamakawa
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Daisuke Takiuchi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Masanori Tsujie
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Yusuke Akamaru
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
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2
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Goh B, Wallace S, Joglekar S. Isolated colorectal metastases to the small bowel presenting with gastrointestinal bleeding. ANZ J Surg 2022; 92:3401-3403. [PMID: 35478376 DOI: 10.1111/ans.17736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/02/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Barnabas Goh
- Department of Surgery, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Sharon Wallace
- Department of Surgery, Ballarat Base Hospital, Ballarat, Victoria, Australia.,Department of Pathology, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Shantanu Joglekar
- Department of Upper GI and Hepatobiliary Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
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Kaila V, Jain R, Lager DJ, Jensen P, Feldman M. Frequency of metastasis to the gastrointestinal tract determined by endoscopy in a community-based gastroenterology practice. Proc (Bayl Univ Med Cent) 2021; 34:658-663. [PMID: 34744302 DOI: 10.1080/08998280.2021.1936361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Metastasis to the gastrointestinal tract is rare. We performed a retrospective analysis to identify patients with metastatic disease to the gastrointestinal tract using two databases containing pathology results from all endoscopic procedures conducted by nearly 200 gastroenterologists in a community setting over a 14-year period. Forty-nine patients were diagnosed with metastasis to the gastrointestinal tract by endoscopy during the study period. Most were women (71%). The most common metastases to the gastrointestinal tract identified by endoscopy were breast cancers (n = 18), followed by melanomas (n = 12), ovarian cancers (n = 7), kidney cancers (n = 5), prostate cancers (n = 2), lung cancer (n = 1), and pancreatic cancer (n = 1). Three patients had unknown primary sites. Among women, the three leading known primary tumor sites were breast, ovary, and melanoma. Among men, the three leading primary tumor sites were melanoma, kidney, and prostate. The stomach was the most common portion of the gastrointestinal tract involved by metastases. Most affected women and were most frequently encountered in the stomach.
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Affiliation(s)
- Vishal Kaila
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Rajeev Jain
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas.,Texas Digestive Disease Consultants, Dallas, Texas
| | | | - Pamela Jensen
- Department of Pathology, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Mark Feldman
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
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Small bowel resection for malignancy. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.696786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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A sequentially metastatic gastric and jejunal cancer originating from colon cancer: A case report. Int J Surg Case Rep 2020; 71:172-175. [PMID: 32470913 PMCID: PMC7260398 DOI: 10.1016/j.ijscr.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
First case of metastatic intraluminal cancer from gastrointestinal tract cancer. Immunohistochemical staining may be useful in sequentially metastatic cancer cases. Adenocarcinomas were derived from colon cancer with CK7, CK20, and CDX2 staining. When an uncommon carcinoma develops researchers should consider previous ones.
Introduction Metastatic intraluminal cancer arising from gastrointestinal tract cancer is very rare. In this report, we describe a case of an 82-year-old man with sequentially metastatic gastric and jejunal cancer originating from primary colon cancer. Presentation of case An 82-year-old Korean male patient with a history of right colon cancer was initially treated with extended right hemicolectomy. The tumour was classified as pT3N0M0 and stage II. After nine months, a gastroscopy revealed an infiltrating ulcerative mass in the cardia of the stomach, a colonoscopy revealed no specific findings in the previous operation site, and a positron emission tomography-computed tomography scan revealed no distant metastasis. The patient underwent radical total gastrectomy, and the final pathologic diagnosis was T3N2M0, stage IIIA. During follow-up without chemotherapy, a gastroscopy revealed tumours in the blind jejunal loop of Roux-en-Y anastomosis, and an endoscopic biopsy confirmed adenocarcinoma. The patient then underwent segmental resection of the blind loop jejunal cancer. Finally, further pathological examination of the resected specimen confirmed that the lesion represented a sequentially metastatic gastric and jejunal cancer originating from colon cancer. Discussion The exact mechanism of intraluminal metastasis of gastrointestinal tract cancer is not known. Immunohistochemical staining might prove useful in sequentially metastatic cases when a differential diagnosis must be assessed on consecutive biopsies. Conclusion Although intraluminal metastasis of gastrointestinal tract cancer is very rare, researchers should be aware of this uncommon intraluminal metastasis.
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Leung KK, Khan U, Zhang M, McCurdy JD, James PD. History of malignancy and relevant symptoms may predict a positive computed tomography enterography in obscure gastrointestinal bleeds. J Gastroenterol Hepatol 2019; 34:1511-1516. [PMID: 30965387 DOI: 10.1111/jgh.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 03/24/2019] [Accepted: 04/03/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM This study aimed to assess the clinical utility of computed tomography enterography (CTE) and identify factors associated with a diagnostic CTE for patients with obscure gastrointestinal bleeding (OGIB). METHODS A retrospective observational study was performed at a Canadian tertiary care center from 2005 to 2015. A total of 138 patients underwent a CTE for OGIB. Univariate and multivariate logistic regressions were performed to determine factors associated with a diagnostic CTE. A highly sensitive clinical rule was then developed to help identify OGIB patients for whom a CTE may be beneficial in their clinical work-up. RESULTS A possible bleeding source was identified in 30 (22%) cases. The presence of abdominal or constitutional symptoms as well as history of colorectal cancer was significantly associated with a positive CTE in univariate and multivariate analyses (P < 0.05). A positive CTE could be predicted based on the presence of abdominal or constitutional symptoms and history of colorectal cancer with 90% sensitivity (95% CI 74-98%) in our population. CONCLUSION CTE identified a possible source of OGIB in one in five cases. In patients with the presence of abdominal or constitutional symptoms and a personal history of colorectal cancer, CTE may contribute to their diagnostic work-up.
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Affiliation(s)
- Kristel K Leung
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Usman Khan
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Mei Zhang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey D McCurdy
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul D James
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Sato H, Shibasaki S, Okabe A, Tsukamoto T, Morise Z, Uyama I. Hematogenous intestinal metastases from sigmoid colon cancer presenting as iliopsoas abscess and bowel obstruction. Int Cancer Conf J 2019; 8:105-108. [PMID: 31218184 PMCID: PMC6545184 DOI: 10.1007/s13691-019-00364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022] Open
Abstract
Intestinal metastases from colorectal cancer typically occur by intraperitoneal spread, whereas those occurring via hematogenous route are exceedingly rare. We report a case of intestinal metastases from sigmoid colon cancer that presented as iliopsoas abscess and ileus. A 78-year-old man who had undergone sigmoidectomy for sigmoid colon cancer 5 years ago was referred to our hospital with recurrent ileus and fever. Abdominal computed tomography showed a left iliopsoas abscess and a mass near the abscess that had ostensibly caused ileus. The patient underwent segmental resection of the jejunum including the mass. Histopathological examination of the resected specimen revealed moderately differentiated adenocarcinoma proliferating mainly in the submucosal and muscular layers, which was pathologically identical to the colon cancer resected 5 years ago. He died 18 months after the surgery because of liver metastases. This case report highlights the delayed occurrence of colorectal metastases at unusual sites, such as the small bowel, more than 5 years after the resection of the primary cancer. Intestinal metastases should be considered in patients with a history of colon cancer, particularly in those with recurrent ileus or abdominal abscess with no obvious cause.
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Affiliation(s)
- Harunobu Sato
- Department of Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Susumu Shibasaki
- Department of Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Asako Okabe
- Department of Pathology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Tetsuya Tsukamoto
- Department of Pathology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Zenichi Morise
- Department of Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Ichiro Uyama
- Department of Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
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Stamopoulos P, Machairas N, Kykalos S, Nonni A, Kouraklis G, Sotiropoulos GC. Intraluminal rectal cancer metastasis to the small bowel: An extremely rare case report. Mol Clin Oncol 2017; 7:553-556. [PMID: 29046790 DOI: 10.3892/mco.2017.1374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/04/2017] [Indexed: 12/16/2022] Open
Abstract
Prolonged survival in patients suffering from colorectal cancer (CRC) may lead to the emergence of rare metastatic sites that are not well-documented in the literature. We herein describe a very rare case of an intraluminal small intestinal metastasis in a patient with previously resected CRC. A 71-year-old Caucasian male patient with a history of rectosigmoid junction cancer was initially treated with anterior resection. The tumor was classified as pT3pN0 (0/26) M0, stage II. Eighteen months after the primary surgery, local recurrence was detected in the presacral region, and the patient received combined image-guided radiotherapy and chemotherapy. Two months later, due to residual disease at the level of the anastomosis, the patient underwent additional low anterior resection with a diverting stoma. During extensive adhesiolysis, a small palpable intraluminal mass was identified in the jejunum, and segmental small bowel resection was performed. Pathological examination of the resected specimen confirmed that the lesion was a metastasis from the CRC primary. The precise mechanism and clinical significance of CRC metastasis to the small bowel remain unclear. There is limited clinical experience with this condition, as <20 cases have been reported in the literature to date. The main symptoms leading to evaluation, diagnosis and surgical resection are bowel obstruction and bleeding. The present case highlights the possibility of uncomplicated presence of metastatic CRC in the small bowel. Therefore, dilligent inspection of the peritoneal cavity, including the entire length of the gastrointestinal canal, is of paramount importance, particularly in cases of recurrent CRC.
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Affiliation(s)
- Paraskevas Stamopoulos
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Athens Medical School, National and Kapodistrian University, 11527 Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Athens Medical School, National and Kapodistrian University, 11527 Athens, Greece
| | - Stylianos Kykalos
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Athens Medical School, National and Kapodistrian University, 11527 Athens, Greece
| | - Afrodite Nonni
- First Department of Pathology, Laiko General Hospital, Athens Medical School, National and Kapodistrian University, 11527 Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Athens Medical School, National and Kapodistrian University, 11527 Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Athens Medical School, National and Kapodistrian University, 11527 Athens, Greece
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9
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Lucke-Wold B, Bonasso PC, Cassim R. Primary colon adenocarcinoma with metastatic disease to the rectum followed by the left axilla. AMERICAN MEDICAL STUDENT RESEARCH JOURNAL 2017; 4:57-61. [PMID: 28393107 DOI: 10.15422/amsrj.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Adenocarcinoma of the colon can metastasize to multiple organs but very rarely metastasizes to the axilla. CASE We present a case of a 56-year-old male with metastatic colon adenocarcinoma that metastasized to the rectum and then the axilla. Three years after initial diagnosis and treatment of right colon mucinous adenocarcinoma a metastatic mass was found in the rectum. The mass was successfully resected, but within a year of finding the rectal mass, metastatic disease to the axilla was discovered. CONCLUSION This case provides valuable teaching points about routes of metastasis and the importance of continued clinical follow-up in patients diagnosed with adenocarcinoma of the colon.
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Affiliation(s)
- Brandon Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV
| | - Patrick C Bonasso
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Riaz Cassim
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV
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10
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Meshikhes AWN, Joudeh AA. Late metastatic colon cancer masquerading as primary jejunal carcinoma. Ann R Coll Surg Engl 2016; 98:e49-51. [PMID: 26890851 DOI: 10.1308/rcsann.2016.0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Metastasis to the small bowel from a previously resected colorectal cancer is rare and may erroneously be diagnosed as a primary small bowel carcinoma. It usually occurs several years after the primary resection. We present the case of a 67-year-old man who had undergone left hemicolectomy for colon cancer 3 years earlier and returned with subacute small bowel obstruction. This was initially thought, based on preoperative radiological findings and normal colonoscopic examination, to be due a primary jejunal cancer. Even at surgery, the lesion convincingly appeared as an obstructing primary small bowel carcinoma. However, the histology of the resected small bowel revealed metastatic colon cancer. This rare and an unusual metastatic occurrence some years after the primary resection is described and reviewed.
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Affiliation(s)
- A-W N Meshikhes
- King Fahad Specialist Hospital, Dammam , Eastern Province , Saudi Arabia
| | - A A Joudeh
- King Fahad Specialist Hospital, Dammam , Eastern Province , Saudi Arabia
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