[Duodenal bleeding due to metastasis from lung adenocarcinoma controlled by radiotherapy: A case report and literature review]. / Saignement duodénal dû à une métastase d'un cancer pulmonaire contrôlé par radiothérapie : cas clinique et revue de la littérature.

INTRODUCTION: Gastrointestinal (GI) metastases in lung cancer rarely occur. CASE REPORT: We report here the case of a 43-year-old male active smoker who was admitted to our hospital for cough, abdominal pain and melena. Initial investigations revealed poorly differentiated adenocarcinoma of the superior-right lobe of the lung: positive for thyroid transcription factor-1 and negative for protein p40 and for antigen CD56, with peritoneal, adrenal and cerebral metastasis, as well as anemia requiring major transfusion support. Over 50% of cells were positive for PDL-1, and ALK gene rearrangement was detected. GI endoscopy showed a large ulcerated nodular lesion of the genu superius with active intermittent bleeding, as well as an undifferentiated carcinoma with positivity for CK AE1/AE3 and TTF-1, and negativity for CD117, corresponding to metastatic invasion originating from lung carcinoma. Palliative immunotherapy with pembrolizumab was proposed, followed by targeted therapy with brigatinib. Gastrointestinal bleeding was controlled with a single 8Gy dose of haemostatic radiotherapy. CONCLUSION: GI metastases are rare in lung cancer and present nonspecific symptoms and signs but no characteristic endoscopic features. GI bleeding is a common revelatory complication. Pathological and immunohistological findings are critical to diagnosis. Local treatment is usually guided by the occurrence of complications. In addition to surgery and systemic therapies, palliative radiotherapy may contribute to bleeding control. However, it must be used cautiously, given a present-day lack of evidence and the pronounced radiosensitivity of certain gastrointestinal tract segments.

Metastases to duodenum in cervical squamous cell carcinoma: A case report and review of the literature.

RATIONALE: Metastases to the duodenum in cervical squamous cell carcinoma are extremely rare, with only 7 cases reported in the published English literature. PATIENT CONCERNS: We present the case of a 66-year-old woman with duodenal metastasis of cervical squamous cell carcinoma who presented with nausea and vomiting within the past 12 days. DIAGNOSIS: Esophagogastroduodenoscopy revealed a circular narrowed 2nd part of the duodenum with congested and edematous mucosa, which was biopsied for a suspected neoplastic lesion. The pathological diagnosis indicated squamous cell carcinoma identical to the original tumor, confirming duodenal metastasis. INTERVENTIONS: The patient received total parenteral nutrition on admission, but symptoms of jaundice soon appeared in the following week, suggesting infiltration of carcinoma into the common bile duct. After percutaneous transhepatic cholangial drainage was performed, jaundice eased in the following 3 days, and an uncovered self-expandable metallic stent was subsequently inserted into the stenosis of 2nd and 3rd part of the duodenum. Subsequently, the patient's diet quickly resumed. OUTCOMES: The patient refused further intervention and was discharged home to continue palliative care at the local hospital. LESSONS: Clinicians should be alert to patients' past medical history to ensure that duodenal metastasis of other tumors is considered in the differential diagnosis. For endoscopists, awareness of such patterns of duodenal stenosis is vital for the accurate recognition of such infrequent diseases.

Clinicopathological features and lymph node and distant metastasis patterns in patients with gastroenteropancreatic mixed neuroendocrine-non-neuroendocrine neoplasm.

OBJECTIVE: Owing to its rarity and heterogeneity, the biological behavior and optimal therapeutic management of mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) have not been established. Herein, we aimed to evaluate the clinicopathological characteristics and metastatic patterns of MiNEN. METHODS: Continuous clinicopathological data of MiNEN patients treated at our hospital were retrospectively collected and analyzed. RESULTS: This study had enrolled 169 patients since January 2010 to January 2020. Pathological components were assessed in 129 patients with MiNEN (76.3%), and a focal (non-)neuroendocrine component was observed in 40 patients (23.7%; <30% of the tumor). Among the enrolled patients, 80 underwent surgical removal of the primary tumor and lymph nodes (LNs), and 34 with distant metastasis underwent biopsy of both primary tumor and metastatic lesions. In patients with LN metastasis, 68.8% (55/80) exhibited a pure component of either neuroendocrine (NE) or adenocarcinoma/squamous carcinoma (AS) in metastatic LNs, while 20% (16/80) showed different components in different LNs, and only 11.2% (9/80) exhibited both NE and AS components in the same LN. In patients with distant metastases, 26.5% (9/34) possessed coexisting NE and AS components in the distant metastases, 70.6% (24/34) were regarded as a pure NE component, and 2.9% (1/34) were comprised of a pure AS component. CONCLUSION: Lymph node and distant metastases exhibited distinct metastatic patterns in patients with MiNEN. The major pathological component in regional LNs may have influenced the proportion of the two components within the primary tumor, but distant metastases were dominated by the NE component.

Metastatic renal cell carcinoma to pancreas and gastrointestinal tract: a clinicopathological study of 3 cases and review of literature.

BACKGROUND: Renal Cell Carcinoma (RCC) metastasizes in approximately 20-30% cases. The most common sites for metastases are the lungs, bones, liver, and brain. Metastases of RCC in the gastrointestinal tract (GIT) are very rare. Metastatic RCC has a poor prognosis. We herein present a case series of three patients with metastatic disease in the colon, duodenum, and pancreas following complete resection of RCC. METHODS: Hematoxylin and Eosin and immunohistochemical slides of 3 cases of RCC metastatic to GIT were reviewed. These cases were diagnosed between 2002 and 2019 at French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan, and Aga Khan University Hospital (AKUH), Karachi, Pakistan. We also present a detailed review of published literature. RESULTS: We reviewed cases of three patients, two females and one male, with a mean age of 57.3 years (range 40-67 years) who underwent nephrectomy for RCC. They developed metastases in the colon, pancreas, and duodenum, respectively 12-168 months (median time 156 months) following primary tumor resection. The patient with metastatic RCC in colon presented with abdominal pain and constipation. An ulcerated mass was found on colonoscopy 30 cm from the anal verge. Diagnosis of RCC with rhabdoid features was confirmed in both primary and metastatic tumors. The second patient developed a metastatic nodule in the head of pancreatic while the third patient developed metastatic nodules in the duodenum and pancreas which were detected by Computed Tomography (CT) scanning. Histopathological examination confirmed the presence of clear cell RCC in the metastatic nodules in both cases. CONCLUSION: Metastatic RCC should be considered in the differential diagnosis of mass in the gastrointestinal (including pancreaticobiliary) tract especially in presence of a past history of RCC. These patients should be screened thoroughly by physical examination and appropriate imaging studies.

A Rare Presentation of Choledochoduodenal Fistula Due to Ovarian Cancer Metastasis.

Choledochoduodenal fistula (CDF) is an abnormal communication between the common bile duct and the duodenum. It accounts for about 5% to 25% of the total biliary fistulas and is usually due to a perforated duodenal ulcer, choledocholithiasis, and complications secondary to tuberculosis or could be iatrogenic. Primary intrabilliary tumors usually cause obstructive jaundice and rarely biliary metastasis arising from other organs like colon, breast, and lungs can cause obstructive jaundice. There has been a case report of metastasis from ovarian cancer to the major papilla of the duodenum but no reported cases of it causing a CDF. We report a rare case of an 83-year-old female with ovarian cancer who developed a metastatic lesion to the duodenum eventually resulting in a CDF.

Metastatic clear cell endometrial carcinoma: an unusual cause of a common clinical presentation.

A 60-year-old woman presented with melena for 2 weeks. She had undergone hysterectomy and bilateral salpingo-oophorectomy to treat clear cell endometrial carcinoma 10 months before the presentation. She was anaemic and tachycardic; abdominal CT scan revealed a large duodenal mass. Her gastrointestinal bleed was not amenable to endoscopic intervention, so she had emergent laparotomy, pancreaticoduodenectomy with duodenal mass excision. Histopathology confirmed that the duodenal mass was a metastatic deposit from her clear cell endometrial cancer. Postoperatively, she was frail and chose hospice care and she died 90 days postoperatively. Clear cell endometrial cancer is a rare subtype of endometrial cancer, that has a worse prognosis compared with the more common endometrioid subtype. The duodenum is a rare site for metastatic endometrial cancer, and we report this case to alert clinicians to the possibility of metastases to the small intestine in patients with clear cell endometrial cancer.

Upper Gastrointestinal Bleeding Due to a Duodenal Metastasis from Primary Testicular Squamous Cell Carcinoma.

BACKGROUND Primary squamous cell carcinoma of the testis (tSCC) is exceptionally rare. To date, only 5 cases have been described in the literature. We report the first case of upper gastrointestinal bleeding due to a duodenal metastasis from tSCC. CASE REPORT We report a male patient who presented with marked swelling of his left scrotum. Inguinal orchiectomy demonstrated keratinizing squamous cell carcinoma (SCC). All surgical margins were negative, and germ cell neoplasia in situ was not identified. PET/CT showed retroperitoneal metastasis. He underwent surgical resection. Three months later, surveillance imaging revealed progression of metastatic disease, including a mass between the transverse duodenum and inferior vena cava invading the duodenal wall without obstruction. Two days later, he presented to the hospital due to gastrointestinal bleeding. CT of the abdomen was negative for a retroperitoneal bleed or intraluminal bleed with stable metastatic retroperitoneal lymph nodes. Esophagogastroduodenoscopy (EGD) showed a fungating and oozing mass in the second portion of the duodenum. Biopsies confirmed metastatic SCC. Palliative radiation and adjuvant chemotherapy were initiated. CONCLUSIONS tSCC, though rare, is an aggressive malignancy and requires prompt and aggressive combined oncological treatment. Most of the cases have been reported to develop from an epidermal cyst, chronic hydrocele, or epididymis. This malignancy can lead to unexpected phenomena such as gastrointestinal bleeding or intestinal obstruction due to its unique metastatic pattern.

Disseminated metastatic cutaneous melanoma to pancreas and upper gastrointestinal tract diagnosed by endoscopic ultrasound: an unusual case.

There is a wide variety of pancreatic neoplasms identified, but the great majority of them are of primary origin. Metastatic disease in the pancreatic parenchyma is quite rare (2-5% of pancreatic malignancies) and most often is quite difficult to differentiate from other primary lesions. Most of the imaging studies fail to give certain discriminating features for metastatic pancreatic neoplasms, contrary to endoscopic ultrasound and tissue sampling, which can provide an accurate diagnosis. In this report, we present a case of a male middle aged man who was admitted to our hospital with painless jaundice and finally was diagnosed with a cutaneous scalp melanoma dispersedly metastasized to the pancreas and upper gastrointestinal tract (stomach and duodenum).

Necrotising fasciitis of the thigh caused by duodenum invasion of renal cell carcinoma: A case report.

Necrotising fasciitis, widespread necrosis of the skin, subcutaneous tissue, and superficial fascia, may be caused by many factors, among which underlying malignancy is observed rarely. We report a case with necrotising fasciitis of the lower extremity because of a duodenum to retroperitoneum fistula caused by renal cell carcinoma invasion. A 62-year-old male with newly diagnosed renal cell carcinoma was diagnosed with necrotising fasciitis at the end of 2 days in hospital. One day after debridement surgery, biliary contamination of dressings and tomography demonstrated fistulation from the duodenum to retroperitoneum and then to the right thigh because of renal tumour invasion. The second operation was performed to repair the duodenum. Intravenous antibiotics and hydration were maintained postoperatively. Although there was no surgical complication, the patient died because of respiratory collapse at the 12th day postoperatively. Renal cell carcinoma may invade the duodenum and, with retroperitoneal fistulation, may be the cause of necrotising fasciitis of the thigh. Laparotomy may be needed to control the origin of infection. However, necrotising fasciitis may be fatal in spite of aggressive treatment. The fasciitis should be diagnosed early to initiate timely aggressive treatment, and a possible endogenous source should be kept in mind.

Solitary adrenal metastasis from advanced gastric cancer invading duodenal bulb with situs inversus totalis: A case report.

RATIONALE: Situs invsersus totalis (SIT) is a rare anomaly featured by complete inversion of abdominal and thoracic organs. Adrenal metastasis is often encountered as part of advanced systemic dissemination, which is usually unresectable. Few published cases reported the adrenal metastasis from gastric cancer with SIT and the treatment of gastrectomy combined with adrenalectomy, especially with intraoperative radiotherapy (IORT). PATIENT CONCERNS: A 61-year-old SIT man found a mass on the right clavicle and the biopsy revealed a metastatic cancer. Around 14 years ago, he had a rectal cancer resection surgery and no sign of occurrence. Five months later, the patient had a pain in his right low abdomen and abdominal CT found a right adrenal mass. DIAGNOSES: Gastroscopy and the pathology revealed the gastric antrum cancer invading the duodenal bulb. Abdominal enhanced CT suspected the adrenal mass as a hematoma, but positron emission tomography computed tomography suspected it as the metastases of gastric cancer which is consistent with the pathology results. Finally, the SIT patient was diagnosed with primary gastric cancer invading duodenal bulb with solitary right adrenal metastasis. INTERVENTIONS: The patient was treated with curative distal gastrectomy and Billroth-II anastomosis with D2 lymphadenectomy. A total 18 Gy intraoperative radiotherapy (IORT) using low energy x-rays by Intrabeam were given after resection. OUTCOMES: The patient had liver metastasis in the seventh month after surgery but there is no sign of local recurrence until now. LESSONS: Gastric cancer with adrenal metastasis, especially with SIT is rare and intractable. The result suggested that active surgical treatment for resectable gastric cancer and solitary adrenal metastatic tumor, especially in combination with IORT may be an option in controlling local relapse and prolonging survival in selected patients.

Secondary gastroduodenal plasmacytoma in a patient with multiple myeloma.

We present an exceptional case of secondary gastroduodenal plasmacytoma in the course of multiple myeloma and we discuss the clinical presentation, images obtained by endoscopy and computed tomography, treatment and clinical course.