Feasibility of Synchronous Liver Metastasectomy During Emergency Colorectal Surgery: A Case Report.

Colorectal cancer (CRCa) is the most frequent gastrointestinal (GI) malignancy, while the liver is the most common site of distant metastases from CRCa, arising from hematogenous spread mainly via the portal venous system. The multiform nature of tumor presentation necessitates a comprehensive approach to diagnosis, perioperative care, and oncological treatment strategy. Herein, we present a case of a 76-year-old male patient diagnosed with obstructive bowel ileus due to a sigmoid tumor with synchronous, suspicious for metastasis, liver lesion who underwent Hartmann's sigmoidectomy in conjunction with left lateral hepatic resection at the same time. Intraoperatively significant blood loss occurred, while the postoperative course of the patient included pulmonary embolism (PE) six days after the procedure, being discharged on postoperative day (POD) 21. After oncological consensus, the patient underwent adjuvant chemotherapy and his reevaluation nine months after surgery confirmed that he is free of active disease. It is evident, however, that the number of existing studies concerning synchronous metastasectomy alongside CRCa resection in an emergency setting is limited and the literature gaps on this matter emphasize the need for further research.

Synchronous Double Primary Tumors of Liver (Small Cell Neuroendocrine Carcinoma and Hepatocellular carcinoma): A Case Report.

This study presents a case of dual primary liver cancer involving small cell neuroendocrine carcinoma and hepatocellular carcinoma. The 58-year-old Chinese male patient, who has a medical history of viral hepatitis B, presented with right upper abdominal pain persisting for one month. Imaging studies indicated the presence of multiple liver masses in segments V and VII-VIII, as well as a mass in the left lung. Subsequent hepatic biopsy performed on both segments confirmed the presence of hepatocellular carcinoma in segment V and small cell neuroendocrine carcinoma in segment VII-VIII. After undergoing one cycle of chemotherapy, the lung mass exhibited a reduction in size, while the liver masses showed an inadequate response. Subsequently, the patient underwent Transcatheter Arterial Chemoembolization (TACE) and Hepatic Artery Infusion Chemotherapy (HIAC), resulting in partial remission (PR). However, the patient was diagnosed with brain metastasis and subsequently treated with Sorafenib and Tirelizumab, a Programmed Death 1 (PD-1) immune checkpoint inhibitor. The efficacy evaluation indicated stability, and no severe adverse effects were observed at the time of writing. The patient's survival time was 16 months.

Synchronous Papillary and Follicular Carcinoma with Scalp and Nodal Metastasis: A case report with review of literature.

Collision tumor comprise of existence of two histologically distinct and separate neoplasms in any organ. Thyroid gland is an uncommon site for these tumors, with frequently involved organs being liver, adrenal and stomach. Even among the synchronous tumors of thyroid, papillary and medullary carcinoma are most commonly reported. The present case reports a rare presentation of a collision tumor comprising of papillary and follicular carcinoma with scalp metastasis from the follicular carcinoma and lymph nodal metastasis from the papillary component. It is essential for the clinician to be aware of such an entity so as to guide further treatment and management.

Urothelial Carcinoma of the Renal Pelvis with Synchronous Ipsilateral Collecting Duct Carcinoma: Two Case Reports.

Synchronous renal malignancies are seldom encountered or diagnosed post-renal resection. A combination of renal cell carcinoma (RCC) and urothelial carcinoma (UC) is most commonly reported. Typically, the RCC subtype is clear-cell RCC; however, a combination of collecting duct carcinoma (CDC) and UC has rarely been reported in the existing literature. Here, we present two cases of synchronous renal malignancy, specifically a combination of CDC and UC, in the ipsilateral kidney.

The Fast Growth and Quick Spread of Synchronous Tumors.

A 47-year-old man was diagnosed with left buccal squamous cell carcinoma using FDG PET/CT, by which focal lesions in the left buccal and left neck lymph node were found. Three months after the operation, CT images revealed a left lower lung lesion. Pathology indicated a left lower lung adenocarcinoma. Second FDG PET/CT was performed more than 11 days later, and lesions with intense FDG uptake were found in the left lower lung, metastatic to the lymph nodes, lungs, bones, and liver. The prior FDG PET/CT scan showed negative findings in the lungs. However, lung cancer with multiple metastases appeared 4 months later.

Utility of FDG PET/CT in Patient with Synchronous Breast and Colon Cancer.

The most common malignancy in women is breast cancer, and the second one is colon cancer. Synchronous breast and colon cancers are rare. Here, we reported a 60-year-old woman with a left breast mass for six months. Biopsy revealed an invasive ductal carcinoma. She underwent 2-[Fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan for evaluation of the extent of the disease. FDG PET/CT revealed an advanced left breast cancer with multiple metastases in both regional and distant lymph nodes (in left axilla level I/II, lower paratracheal region, and right lung hilum), bilateral lungs, and axial and proximal appendicular skeletons. An early staged synchronous colon cancer was detected incidentally on FDG PET/CT images. After endoscopic mucosal resection of colon cancer, she received palliative chemotherapy for breast cancer with a marked therapeutic response. The disease status of post-treated breast cancer remained relatively stationary for more than one year. Brain metastasis was noted afterward. Nevertheless, there was no evidence of colon cancer recurrence throughout her breast cancer disease course.

Synchronous occurrence of gastric adenocarcinoma and MALT-type lymphoma: A case report and literature review.

The coexistence of multiple primary malignant tumors in an organ is rare. This includes the extremely rarely reported combination of gastric adenocarcinoma and gastric MALT-type lymphoma as synchronous tumors. We describe a case of a 72-year-old man diagnosed with this combination. He had no remarkable medical history and came to our hospital because of discomfort in the gastric area. Although the biopsy revealed adenocarcinoma only, the microscopic findings after partial gastrectomy incidentally showed additional lymphoma that was subsequently confirmed by immunohistochemistry as MALT-type lymphoma. This case study and literature analysis aims to raise awareness of the possibility of synchronous malignant neoplasm in the stomach to enhance preoperative diagnosis.

Ipsilateral synchronous papillary and clear renal cell carcinoma: A case report and review of literature.

BACKGROUND: There is limited information on ipsilateral synchronous papillary renal cell carcinoma (PRCC) and clear cell renal cell carcinoma (CCRCC). Therefore, these rare tumors are often misdiagnosed preoperatively as a single tumor with intrarenal metastasis or some other diseases. Effective management and long-term overall survival might be affected because the prognosis of the two tumors differs. CASE SUMMARY: We describe a case of ipsilateral synchronous PRCC and CCRCC with two histological variants in a 72-year-old man, whose mass was found incidentally, with no other chief complaints and vital signs were normal. Initial ultrasound revealed a hypoechoic lobular mass with a volume of 7.8 cm × 4.8 cm × 2.8 cm in the middle to lower pole of the left kidney. A subsequent contrast-enhanced computed tomography scan showed a single endophytic mass of 7.5 cm in diameter. The patient underwent laparoscopic left radical nephrectomy. A final diagnosis of ipsilateral synchronous PRCC and CCRCC was confirmed by pathological examination. There was no recurrence or metastasis after 25 mo follow-up. CONCLUSION: We report a case of ipsilateral synchronous PRCC and CCRCC, and review related literature to estimate the prevalence of similar cases. The above descriptions may be expected to help understand the disease, and improve diagnosis in the future.

Synchronous Gastrointestinal Stromal Tumor (GIST) with pancreatic adenocarcinoma: A case report.

Introduction: Gastrointestinal Stromal Tumors (GIST) are rare mesenchymal neoplasm of gastrointestinal tract. Stomach is the most common site affected by GIST compared to other places in gastrointestinal track. The coexistence of GIST with another malignancy represents a rare phenomenon with few literature reported. Case presentation: We present here 65 years old patient with stomach GIST and synchronous pancreatic adenocarcionoma discovered during surgery for suspected pancreatic mucinious cystadenoma. Distal pancreaticosplenectomy with excision of GIST Tumor & wedge resection of stomach was done. Histopathological examination of resected specimens reported the margins are clear. Discussion: In this article we discuss on the option of systemic therapy versus upfront surgery and their outcome benefit based on literature review. Conclusion: The coexistence of GIST with pancreatic adenocarcinoma is a rare condition. High clinical analysis needed during laparotomy for GIST to detect a synchronous tumor. In a case of GIST the surgeon should recognize the possibility of another tumor with different histological origin. Surgical excision is the mainstay of therapy and it has proven to be curative for our patient. . Due to its rare occurrence and limited literature further studies has to be done on GIST with other synchronous tumor to help the surgeon to manage the patient optimally.

Acoustic Neurinoma with Synchronous Ipsilateral Cerebellopontine Angle Lipoma: A Case Report and Review of the Literature.

Lipomas of the cerebellopontine angle (CPA) and internal auditory canal (IAC) are relatively rare tumors. Acoustic neurinoma is the most common tumor in this location, which often causes hearing loss, vertigo, and tinnitus. Occasionally, this tumor compresses the brainstem, prompting surgical resection. Lipomas in this area may cause symptoms similar to neurinoma. However, they are not considered for surgical treatment because their removal may result in several additional deficits. Conservative therapy and repeated magnetic resonance imaging examinations for CPA/IAC lipomas are standard measures for preserving cranial nerve function. Herein, we report a case of acoustic neurinoma and CPA lipoma occurring in close proximity to each other ipsilaterally. The main symptom was hearing loss without facial nerve paralysis. Therefore, facial nerve injury had to be avoided. Considering the anatomical relationships among the tumors, cranial nerves, and CPA/IAC lipoma, we performed total surgical removal of the acoustic neurinoma. We intentionally left the lipoma untreated, which enabled facial nerve preservation. This report may be a useful reference for the differential diagnosis of similar cases in the future.

Schwannoma pancreático como tumor sincrónico. Reporte de caso / Pancreatic schwannoma as a synchronous tumor. Case report

Los Schwannomas son tumores derivados de las células de Schwann de las vainas de los nervios periféricos. Se pueden localizar en cualquier región anatómica que contenga tejido nervioso periférico, siendo más frecuentes en la región craneofacial y las extremidades. Los Schwannomas pancreáticos son entidades sumamente infrecuentes de las cuales solo se han descrito 68 casos a nivel mundial. En el presente trabajo se presenta el caso de un paciente con hallazgo incidental de tres tumores sincrónicos dentro de los cuales se encuentra un Schwannoma pancreático.Caso clínico : Paciente femenino de 66 años de edad con antecedente de diabetes mellitus tipo 1 y enfermedad diverticular pancolónica quien acude presentando cuadro clínico compatible con absceso lumbar izquierdo. Se realiza TC de abdomen y pelvis con doble contraste que evidencia extensa área de colección heterogénea en región retroperitoneal que diseca hacia región lumbar y glútea izquierda, además de la presencia de tumor hipodenso de bordes lobulados en mesogastrio. Se realiza colonoscopia que reporta lesión exofítica ulcerada en unión rectosigmoidea. El resto de paraclínicos y estudios de extensión se encontraban dentro de límites normales. Se decide resolución quirúrgica mediante drenaje percutáneo de absceso y laparotomía exploradora. Informe histopatológico: cistoadenoma seroso microquístico de cuerpo de páncreas, Schwannoma de cola de páncreas y adenocarcinoma moderadamente diferenciado de colon sigmoides.Conclusión : Los Schwannomas pancreáticos son entidades sumamente infrecuentes que pueden presentarse con una amplia variedad de manifestaciones clínicas, sin embargo, deben tenerse en cuenta como posible diagnóstico diferencial ante el hallazgo de un tumor pancreático(AU)

Schwannomas, also called Neurilemmomas or Neurinomas, are tumors derived from Schwann cells of the peripheral nerve sheaths. They can be located in any anatomical region that contains peripheral nervous tissue, being more frequent in the craniofacial region and the extremities. Pancreatic Schwannomas are extremely rare entities of which only 68 cases have been described worldwide. In the present study we present the case of a patient with an incidental finding of three synchronous tumors, including a pancreatic Schwannoma.Clinical case : A 66-year-old female patient with a history of type 1 diabetes mellitus and pancolonic diverticular disease who presented with symptoms compatible with left lumbar abscess. A double-contrast CT of the abdomen and pelvis was performed, which revealed a large area of heterogeneous collection in the retroperitoneal region that dissected towards the left lumbar and gluteal region, in addition to the presence of a hypodense tumor with lobulated borders in the mesogastrium. A colonoscopy was performed, which reported an ulcerated exophytic lesion at the rectosigmoid junction. The rest of the paraclinical and extension studies were within normal limits. Surgical resolution is decided by percutaneous abscess drainage and exploratory laparotomy. Histopathological report: microcystic serous cystadenoma of the body of the pancreas, Schwannoma of the pancreas tail, and moderately differentiated adenocarcinoma of the sigmoid colon.Conclusion : Pancreatic Schwannomas are extremely rare entities that can present with a wide variety of clinical manifestations, however, they should be taken into account as a possible differential diagnosis when a pancreatic tumor is found(AU)

Left Perforated Colonic Tumor with Synchronous Locally Advanced Right Colonic Tumor.

Colorectal cancer is one of the most common malignant neoplasms worldwide. Overall mortality is 33%. Synchronous colorectal cancer refers to more than one malignant tumor detected in different segments of the colon, simultaneously or within 6 months of initial diagnosis. The development of colorectal cancer is a multistep process that originates with a genetic mutation leading to a malignant phenotype and generating a growth advantage. Colorectal cancer presents up to 16% of hypermutations, of which 75% are characterized by microsatellite instability which in turn leads to poorer cell differentiation. Patients with synchronous tumors appear to have a higher proportion of microsatellite instability than patients with single tumors. The clinical case of a 35-year-old man with a perforated left colon tumor and a locally advanced synchronous tumor of the right colon and signs of acute abdomen is presented. The treatment should be based on the location of the synchronous tumors, stage at the time of approach, and the patient's condition. However, when faced with a complication secondary to colonic cancer, adhering to the principles of oncological surgery can be overcome by the nature of the emergency.

Collision tumor: a colonic adenocarcinoma and a gastric adenocarcinoma.

BACKGROUND: Collision tumors are defined as the juxtaposition of two histologically distinct tumors, which form a single mass, without histological mixing of the two tissues. They are extremely rare, especially in the digestive tract. CLINICAL PRESENTATION: An 81-year-old patient was admitted for anemia, diarrhea and palpable abdominal mass. The colonoscopy showed a substenosing tumor of the transverse colon. On abdominal CT, the colonic mass invaded the stomach. After surgical treatment with transverse colectomy and associated partial longitudinal gastrectomy, pathological results showed that it was a collision between a primary gastric adenocarcinoma and a primary colonic adenocarcinoma. CONCLUSION: We report a first case of collision tumor between a primary gastric adenocarcinoma and a primary colonic adenocarcinoma. Current knowledge on the subject is extremely limited.

The first case report of synchronous primary papillary type 2 renal cell carcinoma of kidney and transitional cell carcinoma of bladder.

Synchronous presentation of Multiple Primary Malignant neoplasms in genitourinary system is not a common event. Absolute majority of reported cases are concurrent outbreak of clear cell type renal cell carcinoma in the kidney and transitional cell carcinoma in ipsilateral renal pelvic. We reported concurrent presenting of two separate primary malignancies, urothelial cell carcinoma of bladder and papillary renal cell carcinoma Type 2 in kidney in a 59-year-old man for the first time.

Synchronous Multiple Primary Cancers of the Lung: The Rare Association of Non-Small Cell Carcinoma With a Carcinoid Tumor.

A 68-year-old female patient diagnosed with lung cancer in the left upper lobe with associated mediastinal adenopathy. The cancer was pathologically diagnosed as stage pT1bN0 typical carcinoid. Investigation of the mediastinal lymph nodes revealed an isolated metastatic non-small cell squamous cell carcinoma (NSCLC). A primary NSCLC was not found. The patient underwent successful surgical resection of both synchronous tumors, with no residual disease or recurrence. This case not only expands the histological field of combined neuroendocrine tumors, but it also highlights the importance of distinguishing various tumor types for disease treatment and prognosis.

Early gastric cancer with three gastric gastrointestinal stromal tumors combined with synchronous colon cancer: a case report.

BACKGROUND: There have been very few reports of patients with early gastric cancer (EGC) and colorectal cancer combined with gastric gastrointestinal stromal tumors (GISTs). CASE PRESENTATION: We report the case of a patient with multiple tumors that were found at the same time in the abdomen. The patient was a 77-year-old man who was referred for a gastric GIST. Esophagogastroduodenoscopy showed the known lesion (a gastric GIST) on the lesser curvature of the upper body and a new lesion on the lesser curvature of the lower body of the stomach with suspicion of EGC. Computed tomography findings confirmed the presence of a GIST in the stomach and revealed two new lesions. One of these lesions was suspected to be a 4-cm submucosal tumor on the anterior wall of the upper body of the stomach. The other was a wall thickening of the descending colon that demonstrated the possibility of malignancy. Synchronous colon cancer was confirmed on colonoscopy. Laparoscopic near-total gastrectomy with D1+ lymph node dissection and left hemicolectomy were performed sequentially without significant events. The patient was discharged without any postoperative complications. CONCLUSIONS: We reported a rare case of EGC with multiple gastric GISTs combined with synchronous colon cancer.

Evolving Strategies for Resection of Sellar/Parasellar Synchronous Tumors via Endoscopic Endonasal Approach: A Technical Case Report and Systematic Review of the Literature.

BACKGROUND: Data on the endonasal endoscopic approach (EEA) to treat sellar/parasellar synchronous tumors remain sparse. This work aims to describe a minimally invasive approach with intraoperative magnetic resonance imaging (MRI) to remove a large sellar/parasellar synchronous tumor, and presents a systematic literature review. METHODS: The preoperative MRI of a 54-year-old woman revealed a sellar lesion (28 × 19 × 16 mm), presumably a pituitary macroadenoma, and a second extra-axial lesion (22 × 36 × 20 mm) expanding from the tuberculum sellae to the planum sphenoidale with encasement of the anterior communicating complex, presumably a meningioma. We used intraoperative MRI to assess the extent of the resection before reconstructing the large skull base defect. Furthermore, we systematically reviewed pertinent articles retrieved by a PubMed/Embase database search between 1961 and December 2018. RESULTS: Out of 63 patients with synchronous tumors reported in 43 publications, we found 3 patients in which the tumor was removed by EEA. In these 3 patients and the presented case, the resection of both lesions was successful, without major approach-related morbidity or mortality. More extensive removal of endonasal structures to gain an adequate tumor exposure was not necessary. We did not find any previous reports describing the benefits of intraoperative MRI in the presented setting. CONCLUSIONS: In the rare case of a synchronous meningioma and pituitary adenoma of the sellar region, intraoperative MRI might be beneficial in confirming residual disease before skull base reconstruction, and therefore radiologic follow-up.

Aparición simultánea de cáncer gástrico temprano y GIST / Simultaneous appearance of early gastric cancer and GIST

Resumen Se presenta el caso clínico de un paciente masculino de 74 años quien ingresó con síntomas de sangrado digestivo alto, se realizó una endoscopia de vías digestivas altas y se encontraron dos lesiones en el estómago: una elevada de centro ulcerado y otra subepitelial, lo que llevó a completar los estudios con una ecoendoscopia gástrica que mostró una lesión mucosa que infiltraba la submucosa sugestiva de cáncer gástrico temprano y otra lesión subepitelial dependiente de la muscular, sugestivas de un tumor gastrointestinal estromal (GIST); los estudios de estatificación no evidenciaron compromiso metastásico, por lo que se llevó al manejo quirúrgico con la posterior confirmación histológica de los hallazgos.

Abstract We present the case of a 74-year-old male patient who was admitted with symptoms of upper digestive bleeding. Endoscopy of his upper digestive tract found an ulcerated lesion and a subepithelial lesion in his stomach. Complete studies including gastric endoscopic ultrasound showed a mucosal lesion infiltrating the submucosa which was suggestive of early gastric cancer as well as a subepithelial lesion on the muscle that was suggestive of a gastrointestinal stromal tumor (GIST). Staging showed no metastatic compromise, so surgery was performed, and histology subsequently confirmed the findings.

Benign Ovarian Tumors in Pregnancy: A Case Report of Metachronous Ipsilateral Recurrent Mucinous Cystadenoma in Initial Pregnancy and Mature Cystic Teratoma in Subsequent Pregnancy.

Mucinous cystadenomas of the ovary are benign epithelial neoplasms that can grow rapidly during pregnancy. They may cause ovarian torsion, virilization, inferior vena cava syndrome, and even preterm labor and fetal growth restriction. Various theories exist regarding the pathogenesis of these tumors. One hypothesis suggests that they may arise from teratomas. Our case report describes synchronous mucinous cystadenomas and ovarian teratomas, as well as metachronous mucinous cystadenomas in patients with a history of ovarian teratoma. There has been no report of metachronous ipsilateral teratoma after previous mucinous cystadenoma. We present a 22-year-old female with a history of bilateral ovarian tumors in a prior pregnancy noted to have a recurrent ovarian mass on her left ovary at the time of cesarean section of a subsequent pregnancy. She had two prior cystectomies for metachronous mucinous cystadenomas of her left ovary, and a right salpingo-oophorectomy for the ovarian torsion in her previous pregnancy. On her current pregnancy, she developed a mature cystic teratoma of the remaining left ovary. The rapid growth and recurrence rate of these tumors highlights the importance of close surveillance of ovarian masses during pregnancy, even those that seem benign. In this case, a history of unilateral salpingo-oophorectomy with multiple contralateral cystectomies did not appear to affect her fertility. Her future ovarian reserve is unknown, pointing to the need for adequate pre-operative counseling in similar cases of ovarian masses in pregnancy.