RESUMO
Dermatofibrosarcoma protuberans (DFSP) is an aggressive tumour with multiple local recurrences and rare metastatic potential. Fibrosarcomatous transformation occurs in a few cases of DFSP which makes them more aggressive in terms of recurrence and metastasis. Here we report the case of a woman in her late 30s who presented with massive lower gastrointestinal (GI) bleeding with a history of multiple surgeries for DFSP on her anterior abdominal wall. The bleeding source was identified to be a mass lesion in the jejunum, which was excised. The patient recovered well and the histopathology revealed fibrosarcoma of the jejunum. Follow-up investigations showed multiple lung nodules, ascites and abdominal lymph nodes suggesting progressive disease. She is currently receiving chemotherapy and progressing well 3 months postoperatively. Patients with fibrosarcomatous changes within DFSP must be followed up closely as it is associated with increased metastatic potential.
Assuntos
Dermatofibrossarcoma , Hemorragia Gastrointestinal , Neoplasias do Jejuno , Neoplasias Cutâneas , Humanos , Dermatofibrossarcoma/complicações , Dermatofibrossarcoma/patologia , Dermatofibrossarcoma/diagnóstico , Dermatofibrossarcoma/secundário , Feminino , Hemorragia Gastrointestinal/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/secundário , Adulto , Neoplasias do Jejuno/secundário , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/cirurgiaRESUMO
A case describes a 49-year-old male patient who underwent emergency exploratory laparotomy for small intestinal perforation. Peritonitis was present due to perforation of the jejunal tumor. Resection of the jejunal tumor with perforation was performed followed by end-to-end anastomosis of the jejunum. The resected jejunal tumor was identified in the histopathological examination as metastatic from a clear cell variant of squamous cell/large cell carcinoma of the lung. It was associated with metastatic lesions in the brain. Metastasis from the lung carcinoma in the jejunum is a very rare condition predisposing to small intestinal perforation which is also associated with brain metastasis.
Assuntos
Neoplasias Encefálicas , Perfuração Intestinal , Neoplasias do Jejuno , Neoplasias Pulmonares , Humanos , Masculino , Pessoa de Meia-Idade , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Perfuração Intestinal/diagnóstico , Neoplasias do Jejuno/secundário , Neoplasias do Jejuno/cirurgia , Neoplasias do Jejuno/diagnóstico , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Encefálicas/secundário , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Grandes/secundário , Carcinoma de Células Grandes/cirurgia , Carcinoma de Células Grandes/diagnósticoAssuntos
Abdome Agudo/etiologia , Adenocarcinoma de Pulmão/secundário , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares/patologia , Doenças Raras/complicações , Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Evolução Fatal , Feminino , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Duodenostomia/métodos , Nutrição Enteral/métodos , Obstrução Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Ultrassonografia de Intervenção/métodos , Adulto , Feminino , Humanos , Obstrução Intestinal/etiologia , Doenças do Jejuno/etiologia , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/secundário , Neoplasias Ovarianas/patologiaRESUMO
We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest-abdomen-pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.
Assuntos
Hemorragia Gastrointestinal/etiologia , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Melanoma/complicações , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Idoso , Anemia/etiologia , Endoscopia por Cápsula , Evolução Fatal , Humanos , Neoplasias do Íleo/secundário , Neoplasias do Jejuno/secundário , Masculino , Melanoma/secundárioRESUMO
BACKGROUND: Rhabdomyosarcoma (RMS), especially primary pulmonary RMS, is an extremely rare type of soft tissue sarcoma in adults. Small bowel is an uncommon site for metastases. CASE PRESENTATION: This report described an unusual case of jejunum metastasis from primary pulmonary RMS causing intussusception in a 75-year-old man. The patient consulted for 2 weeks of continuous dyspnea. Chest computed tomography (CT) demonstrated a large mass involving the left lower lobe. Transthoracic biopsy confirmed the existence of pleomorphic RMS. Immunohistochemical studies showed positive findings about desmin and MyoD1. The results of gastroscopy, colonoscopy and abdominal CT were all negative. Positron emission tomography/CT demonstrated a fluorodeoxyglucose-reactive large lesion in the left lower lobe without metastatic lesions. The patient received synchronous chemoradiotherapy. After 9 months, the patient presented with intermittent upper abdominal pain with nausea and vomiting. CT showed small bowel dilatation secondary to intussusception. The patient subsequently received laparotomy, and the intussuscepted small bowel segment was resected. Histological examination revealed pleomorphic RMS involving the mucosa, submucosa, and muscular tissues. CONCLUSIONS: RMS is highly aggressive and metastatic. The metastatic disease can rapidly progress to cause subsequent complications. The possibility of small bowel metastasis should be considered, although it is extremely rare.
Assuntos
Intussuscepção/etiologia , Neoplasias do Jejuno/complicações , Neoplasias Pulmonares/patologia , Rabdomiossarcoma/complicações , Idoso , Humanos , Neoplasias do Jejuno/secundário , Masculino , Rabdomiossarcoma/secundárioAssuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias do Colo/secundário , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares/patologia , Melena/etiologia , Idoso , Endoscopia por Cápsula , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias do Colo/cirurgia , Colonoscopia , Feminino , Humanos , Neoplasias do Jejuno/cirurgia , Neoplasias Pulmonares/cirurgiaAssuntos
Adenocarcinoma/complicações , Anemia/etiologia , Carcinoma Pulmonar de Células não Pequenas/complicações , Neoplasias Duodenais/complicações , Neoplasias do Jejuno/complicações , Neoplasias Pulmonares/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Duodenais/secundário , Humanos , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , MasculinoRESUMO
In the study of obscure gastrointestinal bleeding, which includes iron-deficiency anemia, the capsule endoscopy is a valuable diagnostic tool. In the different series the presence of tumors reaches 16% as the cause of it. We present the case of a rare tumor with metastatic extension in the small intestine in which the capsule endoscopy was key to the diagnosis and survival of the patient.
Assuntos
Endoscopia por Cápsula , Dermatofibrossarcoma/secundário , Neoplasias Duodenais/secundário , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares/secundário , Neoplasias Cutâneas/patologia , Adulto , Nádegas , Dermatofibrossarcoma/diagnóstico por imagem , Dermatofibrossarcoma/terapia , Neoplasias Duodenais/diagnóstico por imagem , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaAssuntos
Adenocarcinoma/secundário , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Idoso , Feminino , Humanos , Obstrução Intestinal/etiologia , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/patologia , Imageamento por Ressonância MagnéticaRESUMO
Merkel cell carcinoma (MCC) of the skin is a rare but aggressive cutaneous neuroendocrine-derived malignancy that predominantly affects elderly white males. The presence of distant nodal metastases significantly impacts survival. Typical metastatic sites of MCC are liver, bone, brain and skin. Gastrointestinal metastases are uncommon and small bowel is the most common site followed by stomach. We report a case of symptomatic MCC jejunal metastasis.
Assuntos
Carcinoma de Célula de Merkel/secundário , Neoplasias do Jejuno/secundário , Neoplasias Cutâneas , Idoso , Carcinoma de Célula de Merkel/diagnóstico por imagem , Carcinoma de Célula de Merkel/patologia , Feminino , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/patologia , Imageamento por Ressonância Magnética , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: Small bowel intussusception in adults is rarely encountered. In most cases small bowel intussusception is caused by benign neoplastic lesions, but metastasis of cutaneous malignant melanoma causing small bowel intussusception is rare. We present such a case of jejuno-jejunal intussusception with an intraluminal metastatic lesion acting as a lead point. CASE PRESENTATION: We present a case of a 71-year-old Caucasian man who presented with small bowel obstruction. His medical history revealed that he had had a cutaneous malignant melanoma excised 7 years earlier and underwent total laryngectomy due to a metastasis 6 years later. The disease was classified as stage IV and he was receiving immunotherapy. An emergency abdominal computed tomography scan demonstrated small bowel obstruction, most probably caused by an intraluminal lesion. An emergency laparotomy revealed an intraluminal metastatic lesion causing jejuno-jejunal intussusception. Metastasectomy of the lesion was performed and 13 days later he was discharged. CONCLUSIONS: Jejuno-jejunal intussusception with a malignant melanoma metastasis acting as a lead point is very rare. With the gastrointestinal tract being a common location of distal metastases, a medical history of malignant melanoma treatment in cases of small bowel obstruction should raise a suspicion of possible metastatic disease. A computed tomography scan is the diagnostic modality of choice and surgery still remains the standard of care.
Assuntos
Obstrução Intestinal/diagnóstico por imagem , Intussuscepção/tratamento farmacológico , Neoplasias do Jejuno/diagnóstico por imagem , Laparotomia , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Idoso , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intussuscepção/etiologia , Intussuscepção/cirurgia , Neoplasias do Jejuno/secundário , Neoplasias do Jejuno/cirurgia , Masculino , Melanoma/complicações , Melanoma/patologia , Metastasectomia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Melanoma Maligno CutâneoRESUMO
A 59-year-old man who had postoperative recurrence of lung adenosquamous cell carcinoma was administered nivolumab as 3rd-line chemotherapy. Although nivolumab was considered effective, bleeding from a metastatic lesion at the jejunum was recognized by double-balloon enteroscopy, and partial resection was performed. Although the re-administration of nivolumab was planned, the patient died of acute respiratory failure 6 days postoperatively.
Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Carcinoma Adenoescamoso/tratamento farmacológico , Carcinoma Adenoescamoso/secundário , Hemorragia Gastrointestinal/etiologia , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Nivolumabe/administração & dosagem , Doença Aguda , Carcinoma Adenoescamoso/cirurgia , Evolução Fatal , Humanos , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Insuficiência Respiratória/etiologiaRESUMO
Intussusception is a rare condition in the adult population: it is responsible for 1% of all bowel obstructions. In most of intussusceptions a malignant tumor is involved; a lot of studies show that approximately 50% of malignant metastases causing small bowel intussusception are metastatic melanomas. In present paper a case of a small bowel intussusception probably due to metastases of an occult melanoma, in a 69-year-old patient, is presented. Surgery resection, careful research of possible primitive neoplasms and an accurate follow-up program has been the treatment of choice. All the investigations carried out did not allow to identify a possible primitive neoplasm. The last whole body PET carried out 44 months after surgery resulted disease-free.
Assuntos
Intussuscepção/etiologia , Doenças do Jejuno/etiologia , Neoplasias do Jejuno/complicações , Melanoma/complicações , Carcinoma de Células Escamosas , Humanos , Neoplasias do Jejuno/secundário , Neoplasias do Jejuno/cirurgia , Neoplasias Laríngeas , Metástase Linfática , Masculino , Melanoma/secundário , Melanoma/cirurgia , Pessoa de Meia-Idade , Segunda Neoplasia Primária/complicações , Segunda Neoplasia Primária/cirurgia , Neoplasias Primárias DesconhecidasRESUMO
BACKGROUND: How to evaluate the prognostic significance of lymphatic metastasis in patients with small bowel (jejunoileal) neuroendocrine tumors (SBNETs) is still not conclusive. METHODS: Data for patients with SBNETs, but without distant metastasis, were retrieved from the Surveillance, Epidemiology, and End Results database. Recursive partitioning analysis (RPA) was used for classification development by combining examined lymph nodes (ELNs) and lymph node ratio (LNR). RESULTS: Overall, 1925 patient records were retrieved. Patients with N0 and N1 disease (based on the definition of the European Neuroendocrine Tumor Society [ENETS] staging classification) did not have different OS (p = 0.7867), nor did patients with N0, N1 (< 12 positive nodes), and N2 (≥ 12 positive nodes) disease based on the definition of American Joint Committee on Cancer (AJCC) 8th edition staging classification (p = 0.5276). However, Cox regression analysis indicated that both ELNs (hazard ratio [HR] 0.968, 95% confidence interval [CI] 0.949-0.987; p = 0.0013) and LNR (HR 2.288, 95% CI 1.122-3.682; p = 0.0006) were prognostic factors. Using RPA, we combined ELNs and LNR, and patients were reclassified into three groups (group 1: ELNs ≥ 12, any LNR; group 2: ELNs < 12, LNR < 0.35; group 3: ELNs < 12, LNR ≥ 0.35). Survival analysis and multivariate Cox regression showed that groups 1, 2, and 3 had progressively worse survival. Furthermore, we found that ELNs ≥ 12 could remarkably improve patient survival (p < 0.001). CONCLUSIONS: The current definition of lymphatic metastasis could not help predict patient survival. Our newly proposed classification of lymphatic metastasis is better than the ENETS and AJCC 8th edition staging classifications in evaluating the prognostic significance of lymphatic metastasis in SBNETs. Systematic resection of lymph nodes (≥ 12) could help improve patient survival.
Assuntos
Neoplasias do Íleo/secundário , Neoplasias do Jejuno/secundário , Estadiamento de Neoplasias/normas , Tumores Neuroendócrinos/patologia , Feminino , Seguimentos , Humanos , Neoplasias do Íleo/cirurgia , Neoplasias do Jejuno/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Programa de SEER , Taxa de SobrevidaRESUMO
A 76-year-old man with hepatocellular carcinoma associated with alcoholic cirrhosis was hospitalized for lightheadedness and melena. He had undergone multiple surgeries and had been treated with transcatheter arterial chemoembolization and sorafenib. Neither upper nor lower gastrointestinal endoscopy detected the source of bleeding. Oral double-balloon enteroscopy revealed a mass lesion in the upper jejunum, 20 cm from the Treitz ligament on the anal side, which was identified as the source of bleeding. Subsequently, a biopsy was performed. A histopathological examination detected a hepatocellular carcinoma, and a final diagnosis of jejunal metastasis from hepatocellular carcinoma was established.
Assuntos
Carcinoma Hepatocelular/secundário , Neoplasias do Jejuno/secundário , Neoplasias Hepáticas/patologia , Idoso , Biópsia , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Enteroscopia de Duplo Balão , Humanos , Neoplasias do Jejuno/diagnóstico , Neoplasias do Jejuno/patologia , Masculino , Melena/etiologiaRESUMO
Metastatic renal cell carcinoma (MRCC) is a rare cause of massive lower gastrointestinal bleeding (LGIB). We report a 51-year man who underwent left nephrectomy for renal cell carcinoma (RCC) 6 years ago. presenting with massive LGIB. Preoperative abdominal computed tomography (CT) revealed small bowel mass. Exploration of the abdomen revealed jejunal mass. Resection of the mass along with the jejunal segment with end-to-end anastomosis was performed. Histopathology of the jejunal mass confirmed MRCC. MRCC should be expected as a source of massive LGIB in a patient with history of RCC. Surgical intervention should not be delayed in a hemodynamically unstable patient and persistent bleeding.
Assuntos
Carcinoma de Células Renais/patologia , Hemorragia Gastrointestinal/etiologia , Neoplasias do Jejuno/secundário , Neoplasias Renais/patologia , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Hemorragia Gastrointestinal/patologia , Humanos , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Histologically conventional osteosarcoma, once metastasized to the lung, generally causes a rapid and fatal outcome. Osteosarcoma metastasis to the gastrointestinal tract is extremely rare.We report herein a case of osteoblastic osteosarcoma with exceptionally unique features: sporadic lung metastases and delayed metastases to the stomach and the jejunum with long-term survival. She received multiple operations and chemotherapies, but consequently died of peritoneal dissemination. A review of the literature on osteosarcoma metastasis to the gastrointestinal tract is presented.This patient was very unusual in terms of a long-term survival and metastatic sites, suggesting the importance of vigilance and thorough follow-up for patients with conventional osteosarcoma.
Assuntos
Neoplasias Ósseas/patologia , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares/secundário , Osteossarcoma/patologia , Neoplasias Gástricas/secundário , Tíbia , Adolescente , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/cirurgia , Evolução Fatal , Feminino , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias do Jejuno/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/tratamento farmacológico , Osteossarcoma/cirurgia , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Tíbia/diagnóstico por imagem , Fatores de TempoRESUMO
A 71-year-old female presented with melena and anemia. She had a past medical history of renal cell carcinoma diagnosed six years earlier and treated with left nephrectomy. Gastroscopy and colonoscopy showed no abnormalities. Renal cell carcinoma (RCC) is the third commonest urological malignancy, and approximately 25-50% of patients develop metastatic disease after surgery of the primary tumor. The most common sites of metastasis involve lung, lymph nodes, liver, bone and adrenal glands.