An unusual delayed rectal metastasis from prostate cancer masquerading as primary rectal cancer.

INTRODUCTION AND IMPORTANCE: Rectal metastasis of prostate cancer origin is exceedingly rare. Its clinical presentation, endoscopic morphology, and histopathology are similar to primary rectal cancer. Misdiagnosis may lead to inappropriate treatment. CASE PRESENTATION: We report a case of a gentleman in his 80's with a history of treated prostate cancer T3aN0M0 with radical prostatectomy sixteen years ago. He presented with one-year complaints of altered bowel habits and weight loss. Physical and rectal examination was unremarkable. Colonoscopy manifested some inflammatory changes in the rectum. The pelvis magnetic resonance imaging (MRI) showed an abnormal posterior rectal wall thickening 2 cm above the anal canal. Biopsy confirmed poorly differentiated adenocarcinoma of prostate origin. The staging workup was negative for other distant metastasis. After a multidisciplinary decision, the patient was started on androgen deprivation therapy and given palliative radiotherapy to the rectum. Six weeks later, the patient was stable with mild radiation proctitis. CLINICAL DISCUSSION: Management of rectal metastasis varies depending on the patient's choice, the extent of metastatic burden, symptoms, age, life expectancy, quality of life and comorbidities. While surgery remains the standard of care, other option including radiotherapy, hormonal therapy and chemotherapy has been documented in the literature with survival of few weeks to 2 years. CONCLUSION: Delayed rectal metastasis of prostate cancer after radical prostatectomy is a rare entity. Its clinical presentation and endoscopic and histopathological findings of rectal metastasis are similar to primary colorectal cancer, making diagnosis more demanding.

Amaurosis Fugax: A Rare Oxaliplatin-Induced Ocular Toxicity - A Report of Three Cases.

Oxaliplatin, a third-generation platinum-based agent, is a constitutive part of systemic treatment for colorectal cancer in adjuvant and metastatic settings. Ocular toxicity is an extremely rare adverse effect of Oxaliplatin. Ocular toxicities have been documented in the form of (a) common (≥1/100, <1/10) which include the conjunctivitis, unexpected lacrimation, blurry vision, blepharoptosis, and (b) uncommon (≥1/10,000, <1/1,000) which compromise the tunnel vision, idiosyncratic color perception, transient bilateral visual loss, and rarest phenomenon of Amaurosis fugax. Amaurosis fugax implies to any cause of transient, painless, unilateral visual loss; with the possible underlying mechanism of thrombo-embolic carotid plaque, hypoperfusion, or vasospasm of retinal vessels, due to hyperviscosity, and atherosclerotic vascular disease. To date, only a few case reports of Oxaliplatin-induced Amaurosis fugax have been published. We here-in report 3 cases who experienced Amaurosis fugax while receiving Oxaliplatin in our one of health board-based four hospitals.

One patient--three head and neck primaries: nasopharyngeal, tongue and thyroid cancers.

BACKGROUND: We report a rare case of three head and neck malignancies in one patient. Squamous cell carcinoma of tongue and papillary thyroid carcinoma occurred as metachronous cancers in a patient with primary nasopharyngeal carcinoma. These three pathologically distinct malignancies of head and neck region in one patient is a rare phenomenon and is not reported so far. CASE PRESENTATION: A 60 year old Saudi female patient presented in March 2011 with locally advanced nasopharyngeal carcinoma. After completion of concurrent chemoradiation in June 2011, she developed two new primaries i-e thyroid cancer and tongue cancer in May 2012 along with recurrent nasopharyngeal carcinoma. We discuss histopathologic features, diagnostic tools and treatment modalities for this rarely existing case. CONCLUSION: High index of suspicion and thorough work up is essential in follow up of patients with head and neck primary cancers. The effect of field cancerization and environmental factors need to be explored in greater depths in such selected cases. However, which patients are at increased risk of triplet primaries, is still unknown.

Capecitabine induced cardiotoxicity: a case report and review of literature.

Capecitabine is an oral prodrug of 5-fluorouracil (5-FU) which is converted in tumor cells to 5-FU by the enzyme thymidine phosphorylase. Nowadays, it is being widely used into the management of colorectal, breast and head and neck cancers because of its oral route and its comparable efficacy with 5-FU. 5-FU induced cardiotoxicity (angina and myocardial infarction) has been reported the literature, but capecitabine induced cardiotoxicity is less reported event. We report a patient with diagnosis of locally advanced adenocarcinoma of rectum who developed symptomatic bradycardia and acute ischemia while receiving oral capecitabine 825mg/m(2) twice daily with preoperative radiation.