Gastroesophageal adenocarcinoma metastasizing to the chest wall: A case report and mini­review of the literature.

Subcutaneous metastasis from esophageal cancer (EC), particularly to the chest wall, is a very rare phenomenon. The present study describes a case of gastroesophageal adenocarcinoma that metastasized to the chest wall, invading the fourth anterior rib. A 70-year-old female presented with acute chest pain 4 months after undergoing Ivor-Lewis esophagectomy for gastroesophageal adenocarcinoma. A chest ultrasound revealed a solid hypoechoic mass on the right side of the chest. A contrast-enhanced computed tomography scan of the chest revealed a destructive mass on the right anterior fourth rib (7.5x5 cm). Fine needle aspiration revealed a metastatic moderately differentiated adenocarcinoma to the chest wall. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography revealed a large FDG avid deposit on the right side of the chest wall. Under general anesthesia, a right-side anterior chest incision was made and the second, third and fourth ribs were resected with overlying soft tissues, including the pectoralis muscle and overlying skin. The histopathological examination confirmed a metastasized gastroesophageal adenocarcinoma to the chest wall. There are two common assumptions regarding chest wall metastasis from EC. The first one states that this metastasis can occur due to the implantation of the carcinoma during tumor resection. The latter supports the notion of tumor cell dissemination along the esophageal lymphatic and hematogenous systems. Chest wall metastasis from EC invading ribs is an extremely rare incident. However, its likelihood of occurrence should not be neglected following primary cancer treatment.

Aurora rings may not always indicate an inverted colonic diverticulum: Report of a rare case of colonic lipoma.

Aurora rings are prominent endoscopic features of the inverted colonic diverticulum (ICD), and their appearance alongside a colonic lipoma is an unprecedented phenomenon. The present study reports a case of colonic lipoma with Aurora rings, contradicting the assumption that Aurora rings are indicative of ICD. A 52-year-old male patient presented with left-sided abdominal pain for >1 year, associated with constipation in the form of the decreased frequency of bowel motions every 4 to 5 days. A physical examination revealed an obese, protuberant abdomen and a mildly tender left iliac fossa region without other notable findings. A transabdominal ultrasonography revealed a thickening of the large bowel wall (<7 mm) with a suspected inflammatory lesion on the left side of the colon. During an ileocolonoscopy, multiple diffuse diverticula of various sizes were observed, affecting the entire colonic mucosa. Furthermore, a large (1.5 cm) pedunculated polyp with a thick stalk was found in the sigmoid colon, exhibiting positive Aurora rings. A polypectomy was conducted with the deployment of two hemoclips at the polyp base to prevent perforation. The histopathological examination of the specimen, a 1.3 cm polyp, revealed the presence of a colonic lipoma, rather than an ICD. The identification of Aurora rings has emerged as a significant endoscopic feature in the diagnosis of ICD; nevertheless, the underlying etiology of these rings remains elusive. Based on an extensive search of the literature, no study was found mentioning the appearance of Aurora rings in an endoscopic screening of other colonic conditions other than ICD. The appearance of Aurora rings alongside a colonic lipoma has not previously been mentioned, at least to the best of our knowledge, which renders the differentiation of ICD from lipomas and polyps more challenging.