Metastatic adenocarcinoma of the pancreas presents as metastases to the axillary/supraclavicular region as the first sign of the disease

Ileocecal mucinous carcinoma misdiagnosed as incarcerated hernia: A case report

Mucinous carcinoma is a rare clinical disease. Although well described in the literature, a mucinous carcinoma diagnosis is often difficult due to its atypical clinical presentation. We report a female patient with a right inguinal mass and ileocecal myxo carcinoma who was misdiagnosed as having a right incarcerated inguinal hernia invading the peritoneum incarcerated inguinal hernia and ileocecal myxo carcinoma. Intraoperative exploration of the mucous material occupying the patient's right lower abdominal cavity and exclusion of right inguinal incarcerated hernia revealed the misdiagnosis. The first clinical manifestations of ileocecal mucinous carcinoma are often not readily apparent and may be misdiagnosed as an incarcerated inguinal hernia. When a color ultrasonography suggests an incarcerated inguinal hernia, an abdominal CT should be considered, and an enhanced CT should be performed as needed to observe the abdominal cavity. Ileocecal mucinous carcinoma should also be distinguished from other diseases with similar clinical manifestations. The patient had received conservative treatment for acute appendicitis, and it is recommended to conduct a B-ultrasound, CT, and other reviews after surgery. Clinicians should be aware of missed surgical opportunities following appendicitis caused by mucinous adenoma.

Mucinous cystic neoplasms of the pancreas associated with pregnancy: Two case reports

RATIONALE

Although rare, pancreatic neoplasms can occur during pregnancy, both in benign and malignant forms. Mucinous cystic neoplasms (MCNs) of the pancreas, a type of these neoplasms, are precursor lesions to invasive pancreatic cancer. The presence of the ovarian-type stroma is a defining feature.

PATIENT CONCERNS

The first case was a 38-year-old woman in her 18th week of pregnancy with abdominal pain that worsens a few weeks later. The second case was a 30-year-old woman in her 17th week of pregnancy with abdominal pain in the left hypochondrium.

DIAGNOSIS

The patients were under clinical examination and laboratory test including carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). Both patients had magnetic resonance imaging (MRI). The diagnosis of a MCNs of the pancreas was done preoperatively in the 2 cases.

INTERVENTIONS

Both patients underwent distal pancreatectomy during pregnancy. One of them was an emergency laparotomy because of a ruptured MCN.

OUTCOMES

Both patients were completely recovered from distal pancreatectomy and continued to full term, delivering a healthy baby by Caesarean section. After 6 years of follow-up, the first patient underwent a total gastrectomy, because of a gastric cancer with carcinomatosis. Currently the 2 patients are still alive after 8 years and 5 years of follow-up, respectively.

LESSONS

Surgical resection of MCNs during pregnancy should be considered during the second trimester given common distal pancreas location, rapid growth, risk of spontaneous rupture, and malignant potential.

Colonic mucinous adenocarcinoma causing intussusception and distant metastasis: A case report

RATIONALE

Cases of intussusception caused by mucinous carcinoma have been rarely reported, and those caused by colonic mucinous adenocarcinoma (MAC) with distant metastasis were even fewer.

PATIENT CONCERNS

A 60-year-old woman who complained of severe pain around the navel with nausea and vomiting for a week was admitted on November 28, 2017. There were multiple watery stools and abdominal pain was worsened over the prior week.

DIAGNOSIS

She was diagnosed by abdominal computed tomography, current medical history, and abdominal signs. Her initial diagnosis was acute abdomen, intussusceptions, and intestinal obstruction. The final diagnosis was MAC, which was based on postoperative pathology.

INTERVENTIONS

The patient received emergency laparotomy, followed by 5 courses of chemotherapy with oxaliplatin plus capecitabine, and then 6 courses with 5-fluorouracil + oxaliplatin + calcium leucovorin.

OUTCOMES

The patient was in good nutritional condition, and no obvious tumor recurrence or metastasis was found until July 9, 2018.

LESSONS

Even though the prognosis of colonic MAC is poor, being able to receive timely surgical treatment, good nutritional status and reasonable postoperative chemotherapy are the key factors to prolonging patient's survival.