Colon cancer metastasis to the thyroid gland: A case report

IntroductionThyroid metastases from colorectal cancer are uncommon and few cases are described in literature.Case presentationA 64-year-old female patient presented with an asymptomatic right cervical nodule with a rapid growth six years after sigmoidectomy for cancer and two years after resection of colorectal lung metastases. Increased CA 19.9 was identified and a thoracoabdominal CT scan revealed the onset of new metastatic bilateral pulmonary lesions. Neck ultrasonography showed a suspicious nodule in the right thyroid lobe, and Fine-needle Aspiration Cytology (FNAC) of the nodule lead to the diagnosis of colorectal cancer metastasis. A right thyroid lobectomy with right central lymph node dissection was performed. The patient underwent chemotherapy with response, but this was posteriorly suspended due to haematological side effects, and the disease spread.DiscussionThyroid metastases from colorectal cancer are rare, but, with the improvement of radiologic exams and the higher survival rate of these patients, more cases are being described. The majority of the cases present pulmonary and hepatic metastases and the prognosis is poor. The decision to operate and the type of operation depend on the extent of the metastatic disease and the patient’s overall condition.ConclusionA low threshold of suspicion is crucial to make a timely diagnosis of thyroid metastases from colorectal cancer. Treatment is controversial, but, without surgery, the need may arise for tracheostomy.     

Invasive pleomorphic lobular carcinoma of the breast with multiple metastases: A case report

Introduction and importanceIPLC (Invasive Pleomorphic Lobular Carcinoma) accounts for less than 1% of breast cancer. To the best of our knowledge, this is one of the few reported cases in the IPLC with multiple metastases. The patient's general condition got improved after our treatment, which has a certain reference for the treatment of this kind of patient in the future.Case presentationA 42-year-old female with IPLC and multiple metastases. The IPLC malignant cells were positive for p120 (cytoplasmic) and human epidermal growth factor receptor 2, negative for estrogen receptor, progesterone receptor, and E-cadherin. There were nodular enhancement foci in the liver, which are considered the metastatic lesions of the breast, and the liver function was abnormal. Multiple metastatic lesions of the vertebral body, appendage of the whole spine, and sternum. And C7, T1, and T9 vertebrae showed compression fractures.Clinical discussionIPLC has systemic metastasis which molecular typing by immunohistochemistry is HER-2 overexpression can choose chemotherapy combined with targeted therapy to prolong the survival time and improve the quality of life of patients. The patient was followed up.ConclusionsThis paper reports a case of IPLC with multiple metastases and gives review literature. Our treatment of the patient can be a reference for other clinicians.     

Cutaneous metastasis from esophageal basaloid squamous cell carcinoma: A case report

Introduction and importanceBasaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare histologic variant of squamous cell carcinoma. Here, we reported a case of solitary cutaneous metastasis as the first symptom of esophageal BSCC and was successfully treated with multidisciplinary treatment.Case presentationA 67-year-old man visited a local hospital with symptoms of dysphagia and cutaneous nodules on his left shoulder. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed hypermetabolic accumulations in the middle thoracic esophagus, right recurrent laryngeal nerve lymph node, and epidermis of the left shoulder. Esophagogastroscopy revealed an ulcerative and infiltrating type tumor in the middle thoracic esophagus. Based on histopathologic examination of the endoscopic biopsy and the resected cutaneous tumor, the patient was diagnosed as esophageal BSCC with cutaneous metastasis. The patient was treated with chemotherapy followed by chemoradiotherapy. The therapeutic effect was a complete response, which was sustained for 39 months.Clinical discussionReview of previous literature in the PubMed database revealed only been two case reports on cutaneous metastasis of BSCC. Advanced BSCC of the esophagus with distant metastasis has a poor prognosis. Therefore, in our case, future careful follow-up is required.ConclusionEsophageal BSCC with cutaneous metastasis can be successfully managed by multidisciplinary treatment, including local resection of the cutaneous metastasis, systemic chemotherapy, and chemoradiotherapy.     

Perianal squamous cell carcinoma: A case report

Introduction and importancePerianal carcinomas, though rare, are usually squamous cell carcinoma. Current literature recommends surgical excision for tumors staged T1-T2, N0 without external anal sphincter involvement, however our case demonstrated that tumors with superficial involvement of external sphincter fibers can be resected completely.Case presentationA 45-year-old Caucasian male presented with a perianal mass found to be squamous cell carcinoma. Initial imaging suggested the anal sphincter was spared, however intraoperatively tumor cells were found involving superficial external sphincter fibers and a portion was excised to ensure complete removal.Clinical discussionPerianal squamous malignancies are often misdiagnosed as more benign conditions. Treatment aims to preserve sphincter function and depends on tumor stage along with anatomical involvement.ConclusionDespite superficial muscle infiltration, the T2N0 perianal lesion was curable with surgical resection alone without recurrence or functional deficits reported one year later. This suggests surgical management may be possible in some cases with sphincter involvement.     

Total calcanectomy for metastasis of renal cell carcinoma in the calcaneus: A case report

We present a rare case of metastasis of renal cell carcinoma to the calcaneus in a 59-year-old man who presented with pain and inability to bear weight on the left foot 3 years after right nephrectomy for renal cell carcinoma. He successfully underwent en bloc resection of his right calcaneus with a limb salvage procedure, total calcanectomy without bony reconstruction. Histological findings identified the lesion as a metastasis originating from a renal cell carcinoma. Recent follow-up examination showed no recurrence. To the best of our knowledge, this is the first reported case to be treated with total calcanectomy for renal cell carcinoma metastasis.     

Merkel cell carcinoma with bone metastasis: a case report

 A case of Merkel cell carcinoma with bone metastasis is described. The patient, who had a history of Merkel cell carcinoma of the skin in the right cheek, had spontaneous pain in the right thigh. At the initial visit, the right hip range of motion was slightly limited, but there was no gait disturbance or abnormality in the radiographs of the right hip. However, the pain gradually increased and caused gait disturbance. The patient underwent surgical treatment. A bipolar type of femoral prosthesis was implanted into the femur, and sampling of cancellous bone was performed at the time of osteotomy. Pathological examination showed the findings of Merkel cell carcinoma. Merkel cell carcinoma is a rare malignant tumor of the skin, which usually occurs on the head, neck, or extremities and metastasizes to the lymph nodes. Although osseous involvement often occurs in the adjacent facial bones through direct invasion, distant osseous metastasis appears to be extremely rare. Received: November 12, 2001 / Accepted: April 18, 2002     

Primary squamous cell carcinoma of the thyroid gland —A case report

Primary squamous cell carcinoma of the thyroid gland is rare. We report here a case of primary squamous cell carcinoma of the thyroid gland in a middle aged woman who had a thyroid nodule of 12 years duration with a recent rapid increase in size and associated with pressure symptoms. There was massive enlargement of the thyroid with retrosternal extension and fixity. Cervical nodes were also enlarged. The X-rays revealed calcification. A palliative thyroidectomy was done leaving the residual tumour behind. Endotracheal intubation and tracheostomy were required for respiratory distress in the postoperative period.     

A common cancer in an uncommon location: A case report of squamous cell carcinoma of the nipple

IntroductionCutaneous squamous cell carcinoma (SCC) is common however SCC is rarely seen on the nipple, with only ten cases of SCC of the nipple in literature (American Cancer Society, 2015; Scotto et al., 1983; Pendse and O’Connor, 2015; Loveland-Jones et al., 2010; Brookes et al., 2005; Sofos et al., 2013; King and Kremer, 2012; Venkataseshan et al., 1994; Hosaka et al., 2011) [1–9].CaseAn 80 year old female presenting with a chief complaint of an abnormal lesion on the medial portion of her right nipple areola complex. A biopsy showed well-differentiated squamous cell carcinoma. She had an extensive history of prolonged sun exposure predisposing her to cutaneous SCC however none to the breast region. Her mammogram was negative for any invasive disease so a wide local excision was performed with no complications.DiscussionDue to the rarity of SCC of the breast or nipple, a biopsy is necessary to rule out other more common types of malignancies on the nipple that present with a similar physical appearance. We then examined the many different risk factors for SCC and the different methods for treating SCC whether it is cutaneous or of the nipple or breast. We also discussed the treatment of Paget’s disease of the breast (PDB) as SCC of the nipple or breast can be mistaken for PDB.ConclusionThe cases of SCC of the Nipple demonstrate the importance of recognizing changes of the skin even in locations not typically associated with SCC (American Cancer Society, 2015; Scotto et al., 1983; Pendse and O’Connor, 2015; Loveland-Jones et al., 2010; Brookes et al., 2005; Sofos et al., 2013; King and Kremer, 2012; Venkataseshan et al., 1994; Hosaka et al., 2011) [1–9]. We concluded with a future suggestion of investigating possible risk factors specific to SCC of the breast or nipple.     

Renal cell carcinoma with a huge solitary metastasis to the contralateral adrenal gland: A case report

Renal cell carcinoma (RCC) is capable of metastasizing to several organs. Synchronous isolated contralateral adrenal metastasis of the primary RCC is, however, very rare. Herein we report a case of RCC with a huge solitary metastasis to the contralateral adrenal gland that was surgically treated. We scheduled nephrectomy for the left primary RCC and adrenalectomy for the right adrenal tumor. However, at surgery we found a huge right adrenal tumor that had invaded the right kidney, right renal vein, and inferior vena cava. Therefore right nephrectomy was performed simultaneously with resection and reconstruction of the inferior vena cava. Pathological findings demonstrated that the left renal tumor and right adrenal tumor had the same histology. Although the patient required hemodialysis, he remains well at six months postoperatively. So far, there have been only two cases of a solitary contralateral metastatic adrenal tumor that was larger than the primary RCC, thus the present case is the third one.     

Collision tumor of choriocarcinoma and small cell carcinoma of the stomach: A case report

IntroductionBoth gastric choriocarcinoma and small cell carcinoma are extremely rare, both accounting for approximately 0.1% of all gastric cancers. Therefore, simultaneous occurrence of gastric choriocarcinoma and small cell carcinoma is even rarer.Presentation of caseAn 84-year-old Japanese man was referred to our hospital with the chief complaint of dysphagia. Laboratory data showed iron deficiency anemia. Contrast-enhanced computed tomography of the abdomen revealed thickened wall of the stomach at the fundus and several enlarged abdominal lymph nodes. Upper gastrointestinal endoscopy showed a friable gastric tumor with necrosis in the gastric cardia extending to the abdominal esophagus. Small cell carcinoma was diagnosed based on pathological examination of biopsy specimens. The anemia, which was probably because of tumor bleeding, progressed despite repeated transfusion; therefore, a semi-urgent laparotomy was performed to control hemorrhage. Finally, total gastrectomy and lymph node resection were performed. Based on pathological findings, a diagnosis of collision tumor of choriocarcinoma and small cell carcinoma of the stomach was confirmed.DiscussionWhen encountering large tumors with necrosis or hemorrhage in the stomach, the possibility of choriocarcinoma component should be considered. Moreover, when small cell carcinoma is morphologically suspected, even if slightly, additional immunohistochemical staining must be performed.ConclusionThis report detailed an extremely rare case of collision tumor of choriocarcinoma and small cell carcinoma of the stomach.     

Osteosarcoma of the skull base: a case report

Osteosarcoma, usually observed in long bones, is the second most frequent primitive malignant bone tumor after myeloma. The skull base is an exceptional localization. We report a case of skull base osteosarcoma managed in our department. A 23-year-old female was admitted for bilateral epistaxis, headache, decreasing visual acuity then blindness. Physical examination revealed bilateral blindness and exophthalmia. Cranial magnetic resonance imaging showed a voluminous mass in the skull base extending to the nasosinusal area. A rhinoseptal surgical approach was used but the tumor was so huge that excision was impossible. The biopsy identified at an osteoblastic osteosarcoma. Search for extension (chest computed tomography and abdominal ultrasonography) was negative. Chemotherapy was to be delivered before combination chemoradiotherapy but the patient died before any treatment could be started. Osteosarcoma of the skull base is very rare. The treatment is based on surgery which should be as complete as possible followed by chemoradiotherapy. Prognosis is poor. Median survival is around six months.     

Spontaneous rupture of a pancreatic acinar cell carcinoma presenting as an acute abdomen

INTRODUCTIONPancreatic acinar cell carcinoma is a rare malignant pancreatic neoplasm. To the best of our knowledge, there has been no report on spontaneous rupture of acinar cell carcinoma.PRESENTATION OF CASEA 39-year-old Azari male presented with a history of sudden onset, acute epigastric pain of 12-h duration. Eight hours later the patient's general condition rapidly deteriorated, blood pressure was decreased to 90/70 mm/Hg and heart rate was increased to 120 beat/min. Emergent abdominal computed tomography scan showed a well-defined hypo-dense, necrotic mass, measured 12 cm × 12 cm that was originating from the uncinate process of pancreas with marked free peritoneal fluid and extensive haziness of retroperitoneal and mesenteric fat compatible with marked bleeding. Emergent abdominal operation was performed and histopathology revealed acinar cell carcinoma of the pancreas.DISCUSSIONPancreatic acinar cell carcinoma (ACC) usually presents with abdominal pain, nausea and vomiting. To best of our knowledge, no report has been made of spontaneous rupture of ACC.CONCLUSIONPancreatic carcinoma may present as acute abdomen due to rupture of underlying neoplasm.