Ileostomy adenocarcinoma in Crohn's disease.

PURPOSE: Adenocarcinoma of an ileostomy is rare with less than 50 reported cases in the literature. Ileostomy adenocarcinoma in Crohn's disease is even more rare, with only 4 reported cases. We present a case of ileostomy adenocarcinoma with lymph node metastasis occurring 51 years after proctocolectomy and Brooke ileostomy in a female with Crohn's disease. This case represents the longest documented interval between Brooke ileostomy and ileostomy adenocarcinoma diagnosis and summarizes clinical signs that warrant biopsy of a peristomal plaque to differentiate adenocarcinoma from clinical mimics such as pyoderma gangrenosum (PG). METHODS: Clinical, histological, and surgical patient data were reviewed. A literature review of adenocarcinoma arising from ileostomy sites was performed. RESULTS: We report a case of a 67-year-old woman that presented with a peristomal skin lesion developing over 10 years. After multidisciplinary discussion between gastroenterology, colorectal surgery, and dermatology, ileoscopy revealed moderately differentiated, invasive adenocarcinoma arising from the ileostomy site. Wide surgical excision and en bloc resection of the peristomal lesions were performed, and the final pathology revealed lymph node metastasis. The patient is currently undergoing adjuvant chemotherapy. CONCLUSIONS: Clinicians should maintain a high level of suspicion when ileostomy patients develop a peristomal lesion.

Adenocarcinoma of the Cecum with Rare Splenic Metastasis.

Isolated splenic metasisis is a rare finding in colorectal carcinoma. We report a case of metastatic cecal adenocarcinoma to the spleen. In spring 2011, a 53-yearold woman underwent en bloc right hemicolectomy with partial omentectomy. The tumor was Stage III pT3 pN2a M0. She received four months of modified FOLFOX6 chemotherapy and one month of capecitabine. In spring 2012, a PET/CT revealed a low attenuation focus in the spleen consistent with metastatic adenocarcinoma, so she underwent splenectomy. Additional imaging has revealed no disease recurrence. There are only a small number of case reports for isolated splenic metastasis; thus, no standardized treatment course has been developed.

Metastatic melanoma to the gastrointestinal tract: role of surgery as palliative treatment.

BACKGROUND: Malignant melanoma is an uncommon metastatic tumor found in the gastrointestinal tract but most commonly involves the small bowel. Less than 5% of patients with metastases to the gastrointestinal tract are diagnosed antemortem. Clinical presentation could be an acute abdominal emergency such as a bowel obstruction, intussusception, bleeding and perforation or chronic symptoms with weight loss, abdominal pain and anemia. METHODS: We report two unusual cases with acute gastrointestinal complications related to metastatic melanoma. Case 1 developed acute upper gastrointestinal bleeding and was diagnosed with gastric mass. Biopsy revealed metastatic melanoma. The patient died of his advanced disease. Case 2 with unknown primary melanoma presented with acute abdomen secondary to small bowel perforation. He underwent laparotomy and small bowel resection with palliative intent. The patient remains alive and free of symptoms at 4 year follow up. CONCLUSIONS: Metastatic melanoma of the gastrointestinal tract should be suspected in any patient with history of cutaneous melanoma and new gastrointestinal symptoms. Surgical interventions for symptomatic patients with melanoma of the gastrointestinal tract significantly relieve pain and improve quality of life and may confer a survival advantage.

Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial.

Importance: The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy. Objective: To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference's association with geographic and temporal factors. Design, Setting, and Participants: This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022. Exposure: Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals. Main Outcomes and Measures: Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year. Results: A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P < .001) or other screening tests (46 [1.0%] P < .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25). Conclusions and Relevance: In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.

Primary colon adenocarcinoma with metastatic disease to the rectum followed by the left axilla.

INTRODUCTION: Adenocarcinoma of the colon can metastasize to multiple organs but very rarely metastasizes to the axilla. CASE: We present a case of a 56-year-old male with metastatic colon adenocarcinoma that metastasized to the rectum and then the axilla. Three years after initial diagnosis and treatment of right colon mucinous adenocarcinoma a metastatic mass was found in the rectum. The mass was successfully resected, but within a year of finding the rectal mass, metastatic disease to the axilla was discovered. CONCLUSION: This case provides valuable teaching points about routes of metastasis and the importance of continued clinical follow-up in patients diagnosed with adenocarcinoma of the colon.