RESUMEN
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.
Asunto(s)
Dermatofibrosarcoma , Hemorragia Gastrointestinal , Neoplasias del Yeyuno , Neoplasias Cutáneas , Humanos , Dermatofibrosarcoma/complicaciones , Dermatofibrosarcoma/patología , Dermatofibrosarcoma/diagnóstico , Dermatofibrosarcoma/secundario , Femenino , Hemorragia Gastrointestinal/etiología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/secundario , Adulto , Neoplasias del Yeyuno/secundario , Neoplasias del Yeyuno/complicaciones , Neoplasias del Yeyuno/cirugíaRESUMEN
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.
Asunto(s)
Neoplasias Encefálicas , Perforación Intestinal , Neoplasias del Yeyuno , Neoplasias Pulmonares , Humanos , Masculino , Persona de Mediana Edad , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Perforación Intestinal/diagnóstico , Neoplasias del Yeyuno/secundario , Neoplasias del Yeyuno/cirugía , Neoplasias del Yeyuno/diagnóstico , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Encefálicas/secundario , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Grandes/secundario , Carcinoma de Células Grandes/cirugía , Carcinoma de Células Grandes/diagnósticoAsunto(s)
Abdomen Agudo/etiología , Adenocarcinoma del Pulmón/secundario , Neoplasias del Yeyuno/secundario , Neoplasias Pulmonares/patología , Enfermedades Raras/complicaciones , Adenocarcinoma del Pulmón/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Resultado Fatal , Femenino , Humanos , Neoplasias del Yeyuno/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Melanoma/patología , Neoplasias del Yeyuno/diagnóstico , Neoplasias del Yeyuno/secundarioAsunto(s)
Duodenostomía/métodos , Nutrición Enteral/métodos , Obstrucción Intestinal/cirugía , Enfermedades del Yeyuno/cirugía , Ultrasonografía Intervencional/métodos , Adulto , Femenino , Humanos , Obstrucción Intestinal/etiología , Enfermedades del Yeyuno/etiología , Neoplasias del Yeyuno/complicaciones , Neoplasias del Yeyuno/secundario , Neoplasias Ováricas/patologíaRESUMEN
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.
Asunto(s)
Hemorragia Gastrointestinal/etiología , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Yeyuno/diagnóstico por imagen , Melanoma/complicaciones , Melanoma/diagnóstico por imagen , Neoplasias Cutáneas/patología , Anciano , Anemia/etiología , Endoscopía Capsular , Resultado Fatal , Humanos , Neoplasias del Íleon/secundario , Neoplasias del Yeyuno/secundario , Masculino , Melanoma/secundarioRESUMEN
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.
Asunto(s)
Intususcepción/etiología , Neoplasias del Yeyuno/complicaciones , Neoplasias Pulmonares/patología , Rabdomiosarcoma/complicaciones , Anciano , Humanos , Neoplasias del Yeyuno/secundario , Masculino , Rabdomiosarcoma/secundarioAsunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias del Colon/secundario , Neoplasias del Yeyuno/secundario , Neoplasias Pulmonares/patología , Melena/etiología , Anciano , Endoscopía Capsular , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias del Colon/cirugía , Colonoscopía , Femenino , Humanos , Neoplasias del Yeyuno/cirugía , Neoplasias Pulmonares/cirugíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Dermatofibrosarcoma/patología , Neoplasias del Yeyuno/cirugía , Sunitinib/uso terapéutico , Metástasis de la Neoplasia/diagnóstico por imagen , Neoplasias del Yeyuno/secundarioAsunto(s)
Adenocarcinoma/complicaciones , Anemia/etiología , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Neoplasias Duodenales/complicaciones , Neoplasias del Yeyuno/complicaciones , Neoplasias Pulmonares/complicaciones , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundario , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/secundario , Neoplasias Duodenales/secundario , Humanos , Neoplasias del Yeyuno/secundario , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , MasculinoRESUMEN
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.
Asunto(s)
Endoscopía Capsular , Dermatofibrosarcoma/secundario , Neoplasias Duodenales/secundario , Neoplasias del Yeyuno/secundario , Neoplasias Pulmonares/secundario , Neoplasias Cutáneas/patología , Adulto , Nalgas , Dermatofibrosarcoma/diagnóstico por imagen , Dermatofibrosarcoma/terapia , Neoplasias Duodenales/diagnóstico por imagen , Humanos , Neoplasias del Yeyuno/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Masculino , Tomografía Computarizada por Tomografía de Emisión de PositronesAsunto(s)
Adenocarcinoma/secundario , Neoplasias del Yeyuno/secundario , Neoplasias Pulmonares , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Anciano , Femenino , Humanos , Obstrucción Intestinal/etiología , Neoplasias del Yeyuno/diagnóstico por imagen , Neoplasias del Yeyuno/patología , Imagen por Resonancia MagnéticaRESUMEN
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.
Asunto(s)
Carcinoma de Células de Merkel/secundario , Neoplasias del Yeyuno/secundario , Neoplasias Cutáneas , Anciano , Carcinoma de Células de Merkel/diagnóstico por imagen , Carcinoma de Células de Merkel/patología , Femenino , Humanos , Neoplasias del Yeyuno/diagnóstico por imagen , Neoplasias del Yeyuno/patología , Imagen por Resonancia Magnética , Neoplasias Cutáneas/patologíaRESUMEN
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.
Asunto(s)
Obstrucción Intestinal/diagnóstico por imagen , Intususcepción/tratamiento farmacológico , Neoplasias del Yeyuno/diagnóstico por imagen , Laparotomía , Melanoma/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Anciano , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intususcepción/etiología , Intususcepción/cirugía , Neoplasias del Yeyuno/secundario , Neoplasias del Yeyuno/cirugía , Masculino , Melanoma/complicaciones , Melanoma/patología , Metastasectomía , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patología , Resultado del Tratamiento , Melanoma Cutáneo MalignoRESUMEN
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.
Asunto(s)
Antineoplásicos Inmunológicos/administración & dosificación , Carcinoma Adenoescamoso/tratamiento farmacológico , Carcinoma Adenoescamoso/secundario , Hemorragia Gastrointestinal/etiología , Neoplasias del Yeyuno/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Nivolumab/administración & dosificación , Enfermedad Aguda , Carcinoma Adenoescamoso/cirugía , Resultado Fatal , Humanos , Neoplasias del Yeyuno/secundario , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Insuficiencia Respiratoria/etiologíaRESUMEN
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.
Asunto(s)
Intususcepción/etiología , Enfermedades del Yeyuno/etiología , Neoplasias del Yeyuno/complicaciones , Melanoma/complicaciones , Carcinoma de Células Escamosas , Humanos , Neoplasias del Yeyuno/secundario , Neoplasias del Yeyuno/cirugía , Neoplasias Laríngeas , Metástasis Linfática , Masculino , Melanoma/secundario , Melanoma/cirugía , Persona de Mediana Edad , Neoplasias Primarias Secundarias/complicaciones , Neoplasias Primarias Secundarias/cirugía , Neoplasias Primarias DesconocidasRESUMEN
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.
Asunto(s)
Neoplasias del Íleon/secundario , Neoplasias del Yeyuno/secundario , Estadificación de Neoplasias/normas , Tumores Neuroendocrinos/patología , Femenino , Estudios de Seguimiento , Humanos , Neoplasias del Íleon/cirugía , Neoplasias del Yeyuno/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/cirugía , Programa de VERF , Tasa de SupervivenciaRESUMEN
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.
Asunto(s)
Carcinoma Hepatocelular/secundario , Neoplasias del Yeyuno/secundario , Neoplasias Hepáticas/patología , Anciano , Biopsia , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patología , Enteroscopía de Doble Balón , Humanos , Neoplasias del Yeyuno/diagnóstico , Neoplasias del Yeyuno/patología , Masculino , Melena/etiologíaRESUMEN
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.