Primary Squamous Cell Carcinoma of the Cecum: A Case Report.

Primary squamous cell carcinoma (SCC) of the colon is an exceptionally rare diagnosis. The etiology and pathogenesis of this entity remain unclear. It usually presents in patients as an emergency, typically with the tumor in the advanced stage. We report a case of SCC of the cecum presenting with perforation, initially diagnosed as SCC of unknown origin. The patient underwent a limited right hemicolectomy and end ileostomy outside our center. The patient was referred to us for further workup and possible adjuvant chemotherapy. She was assessed clinically and found to have had poor appetite and anorexia for a month, with an intermittent fever documented at 39 degrees. Thus, the patient was elected to get admitted for a septic workup and re-staging by CT scan and tumor biomarkers. CT showed a phlegmon and abscess formation at the right iliac fossa that was attached to surrounding structures, including the abdominal wall. Drain placement at the site of the phlegmon was attempted but failed due to bowel overlapping. Therefore, the patient was booked for surgical exploration and drainage, where all structures were resected en bloc. Histopathological examination revealed well-differentiated keratinized SCC with lymph node metastasis. The diagnosis of primary SCC of the cecum was confirmed after investigations to rule out primary sources were negative. Surgical resection remains the mainstay of management, with a possible role for chemotherapy and radiation therapy. The prognosis in these cases is usually poor. This warrants early diagnosis and management. Studies are needed to establish a management protocol for this entity.

Spontaneous Stoma Closure: A Case Report and Review of the Literature.

Stomas serve various purposes, and surgical closure of temporary stomas is typically performed once the underlying reason for their creation has been resolved. However, spontaneous closure of a stoma without surgical intervention is exceptionally rare. Here, we present a case of spontaneous stoma closure. A 67-year-old female presented with symptoms indicative of partial bowel obstruction. A computed tomography (CT) scan revealed circumferential wall thickening involving the transverse, splenic flexure, and proximal descending colon, along with a dilated proximal colon. Urgent intervention led to a total colectomy with ileorectal anastomosis and the creation of a diverting loop ileostomy. Six months later, she was then booked for stoma closure but found that the stoma was already closed, and the patient reported a history of pushing the stoma inside by herself. Spontaneous closure of a stoma is extremely rare. The mechanism behind spontaneous closure is not fully understood. Stoma retraction or the healing process of an enterocutaneous (EC) fistula can be attributable factors. Only six cases of spontaneous stoma closure have been reported in the literature. The technique that has been described by the patient of pushing the stoma inside has not been discussed before. Gradual retraction of the stoma and the healing process of EC fistula are the most common acceptable factors. The technique of pushing the stoma inside could be a helpful factor in spontaneous stoma closure. Long-term follow-up can help in understanding the unclear mechanism of this condition.

Synchronous Colon and Breast Cancers: A Case Report of Multiple Primary Tumors.

Multiple primary malignant tumors (MPMNs) are not rare entities. We report a case of a 50-year-old female who presented with left upper quadrant abdominal pain and GI bleeding. Initial assessment with CT scan revealed a mass originating from the descending colon. Colonoscopy was performed and a fungating partially obstructed mass at the left splenic flexure was detected. Histopathological examination of biopsy was consistent with mucinous adenocarcinoma. The staging CT scan of the chest and pelvis, followed by a mammogram reported a Synchronous breast mass. Core needle biopsy detected an invasive ducal carcinoma. In the multidisciplinary meeting, it was decided to perform the colon procedure first, followed by adjuvant chemotherapy, and then the breast procedure. The patient had an uneventful recovery after both procedures and was sent to the medical oncology department to continue with the treatment.

Intraoperative Archive of Right Colonic Vascular Variability Aids Central Vascular Ligation and Redefines Gastrocolic Trunk of Henle Variants.

BACKGROUND: Vascular supply to the right colon has become an issue because of high variability and subsequent impact on minimally invasive surgery. Past cadaveric or radiologic anatomic assessments are noncomprehensive. OBJECTIVE: Intraoperative charting of right colonic arteriovenous anatomy was undertaken to determine the incidence and scope of vascular variations. DESIGN: Vascular anatomy variations were documented in snapshot images, captured during laparoscopic video recordings or through open surgical digital photography. SETTINGS: Data were drawn from consecutive right hemicolectomies, routinely entailing complete mesocolic excision with central vascular ligation. PATIENTS: Seventy patients (mean age, 62.7 years; 37 women (52.8%); 33 men (47.2%)), each with surgically treatable right-sided colon cancer, were prospectively studied. RESULTS: Both ileocolic and middle colic arteries were regularly identified (100%), with right colic artery present in 41.4% of patients. Ileocolic and middle colic veins consistently drained into the right colon. Although the ileocolic vein always emptied into the superior mesenteric vein, drainage of the middle colic vein was split (superior mesenteric vein, 94.3%; gastrocolic trunk of Henle, 5.3%), as was drainage of the right colic (superior mesenteric vein, 43.3%; gastrocolic trunk of Henle, 56.7%) and accessory middle colic veins (superior mesenteric vein, 54.5%; gastrocolic trunk of Henle, 45.5%), present in 42.9% and 15.7% of patients. Gastrocolic trunk of Henle was found in 88.6% of patients, usually draining into the superior mesenteric vein. No significant sex-related differences were present regarding the incidence and scope of variability displayed by the right colic artery, right colic vein, accessory middle colic vein, or gastrocolic trunk of Henle classification (p > 0.05). LIMITATIONS: The inconsistency between cadaver and live surgery anatomy and the low BMI of the Asian population might be drawbacks of our study. CONCLUSIONS: Variations in right colonic arteriovenous channels, assessed intraoperatively, corroborate those established by cadaveric and radiologic means, prompting a new gastrocolic trunk of Henle classification.

Surgical management of extra-regional lymph node metastasis in colorectal cancer.

One of the major problems in rectal cancer surgery is local recurrence, found in an average of 21% to 46% cases in 1990. However, the advent of chemo-radiotherapy (CRT) and total mesorectal excision (TME) improve local control and enhances survival rates in colorectal cancer (CRC). Regional lymph node involvement is determined to be an independent prognostic factor in local recurrence; however, extra-regional lymph node (ERLN) metastasis has a higher recurrence rate (up to 58.1%). Lack of supportive data in management of ERLN metastasis in CRC has added further strain and challenges to structure a unique treatment strategy. ERLN refers to extra-mesenteric involvement either in the para-aortic lymph node (PALN) or the lateral pelvic lymph node (LPLN). Treatment of ERLN metastasis is challenging because of the shortage of the resources. Here, we will outline and summarize approaches and management of ERLN metastasis. We also aim to clarify the role of surgical intervention in CRC.