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Synchronous adenocarcinoma and carcinoid tumor of the terminal ileum in a Crohn's disease patient
Ugo Cioffi, Matilde De Simone, Stefano Ferrero, Michele M Ciulla, Alessandro Lemos, Ettore Avesani
BMC Cancer , 2005, DOI: 10.1186/1471-2407-5-157
Abstract: The patient presented with clinical and radiological features of intestinal obstruction. Laparotomy showed a stricturing lesion in the last 6 cm of the terminal ileum with proximal dilation. Only the histology of the resected surgical specimen proved the presence of a mixed adenocarcinoid tumor involving the terminal ileum.Carcinoid tumor should be suspected in elderly patients with Crohn's disease presenting with intestinal obstruction and laparotomy should be considered to exclude malignancy.It has been recognized that patients with Crohn's disease (CD) are at increased risk of developing malignant lesions [1,2]. Adenocarcinoma is one of the most common malignant tumors of the small intestine complicating CD, even if it remains quite rare compared with the large bowel malignancies [3-5]. Carcinoid tumors have also been described in association with CD [6,7].We report here a case of ileal Crohn's disease associated with both adenocarcinoma and carcinoid tumor.A 64-year old woman was admitted to the Gastroenterology Unit of another Hospital for abdominal pain, nausea, weight loss, and recurrent episodes of constipation. She had suffered from intermittent pain located in the right lower quadrant for 2 years, but denied chronic diarrhea. She was diagnosed as having Crohn's disease of the terminal ileum by ileocolonoscopy and histology. An upper gastrointestinal series excluded CD in the upper gastrointestinal tract.After inductive therapy with azathioprine and corticosteroids, the patient was maintained with mesalazine 500 mg × 4 daily. Prednisone 50 mg/day was added only during acute phases; in the six years following the discharge, 2 episodes of abdominal pain and dyarrhea requiring steroid therapy were recorded. Seven years later the patient was admitted to our Institution for abdominal pain, nausea, iron deficiency anemia, hypoalbuminemia, and intestinal obstruction. On physical examination no masses in the abdomen were noted. Small bowel double-contrast enterocly
O. Ciobotaru,Oana-Roxana Ciobotaru,Cr. Dragomir
Jurnalul de Chirurgie , 2011,
Abstract: Carcinoid tumors are the second most common tumor of small bowel (after adenocarcinoma) and are most commonly found in the ileum. Between 1998 and 2009, there were studied 73 patients diagnosed with intestinal tumor in three hospitals in Iasi and Galati. Carcinoid tumors represents 15,38% of malignant tumors of jejunum and ileum. The average age of diagnosis was 60 years, 38% female and 62% male. 62,5% of patients came from urban areas and 37,5% in rural areas. Distal tumors (in the ileum) are more frequent than proximally located tumors (in the jejunum), incidence was 3:1. The main signs and symptoms were nonspecific: abdominal pain (100%), flatulence and nausea (75%). There were no correlations between admission and discharge diagnosis. The percentage of specimens positive for markers was as follows: Leu-7 87,5%, neuron-specific enolase (NSE) 75%, chromogranin A (CgA) 75%, serotonin 62,5%, S100 protein 12,5%. Gastrointestinal radiology, ultrasound and CT were helpful in diagnosis, but none of them did not put the certain diagnosis in all cases that it has been made. At the moment of diagnosis half of patients had ganglion metastasis and 12,5% had metastasis, therefore only 12,5 percent survived after five years The results show us that preoperative diagnosis is often difficult to make, most of patients were diagnosed in advanced-stage. The five-year survival rate is slow. The most frequent tumor markers were Leu-7, neuron-specific enolase and chromogranin A.
A novel combination of multiple primary carcinomas: Urinary bladder transitional cell carcinoma, prostate adenocarcinoma and small cell lung carcinoma- report of a case and review of the literature
Anastassios V Koutsopoulos, Konstantina I Dambaki, George Datseris, Elpida Giannikaki, Marios Froudarakis, Efstathios Stathopoulos
World Journal of Surgical Oncology , 2005, DOI: 10.1186/1477-7819-3-51
Abstract: We report a case of a man in whom urinary bladder transitional cell carcinoma, metachronous prostate adenocarcinoma and small cell lung carcinoma were diagnosed within an eighteen-month period. The only known predisposing factor was that he was heavy smoker (90–100 packets per year). The literature on the phenomenon of multiple primary malignancies in a single patient is reviewed and the data is summarized.It is important for the clinicians to keep in mind the possibility of a metachronous (successive) or a synchronous (simultaneous) malignancy in a cancer patient. It is worthy mentioning this case because clustering of three primary malignancies (synchronous and metachronous) is of rare occurrence in a single patient, and, to our knowledge, this is the first report this combination of three carcinomas appearing in the same patient.The phenomenon of multiple primary malignant neoplasms in the same individual was described firstly by Billroth at the end of the 19th century [1]. Since then, several cases of double or even triple primary malignant neoplasms have been reported. It is believed that multiple primary malignant neoplasms now occur more frequently than before. Although, not uncommon, they occur more often in elderly patients, as the incidence of malignancies increases with age. The diagnosis of second primary neoplasms is rising as a result of prolonged survival of patients treated for previous malignancy with alkylating agents, topoisomerase II inhibitors, and/or radiotherapy[2]. A review of the recent literature indicates clearly that they appear more frequently in the upper digestive tract, respiratory system, head and neck region, or urogenital system; the reported incidence ranges from 2% to 10% [3].In this report we present a patient who developed primary bladder carcinoma and metachronous prostate and small cell lung carcinoma (SCLC) within an eighteen-month period. This combination of multiple primary carcinomas, to our knowledge, has never been repo
Adenocarcinoma of the caecum metastatic to the bladder: an unusual cause of haematuria
Benjamin R Grey, Laurence Clarke, Satish B Maddineni, Roger Hunt, Richard J Brough
BMC Urology , 2006, DOI: 10.1186/1471-2490-6-29
Abstract: The report describes the case of a 45-year old male with Duke's B caecal carcinoma treated with a laparoscopically-assisted right hemicolectomy and adjuvant 5-Fluorouracil chemotherapy. Subsequently, a metastatic lesion to the bladder was demonstrated and successfully excised by partial cystectomy.In order that optimal therapeutic options can be determined, it is important for clinicians to distinguish between primary disease of the bladder and other causes of haematuria. Various immunohistochemical techniques attempt to differentiate primary adenocarcinoma of the bladder from secondary colorectal adenocarcinoma. Suspicion of metastatic disease must be raised when histologically unusual bladder tumours are identified.The vast majority of bladder tumours are primary transitional cell carcinomas. Primary adenocarcinomas of the bladder are rarer but well recognized. Secondary neoplastic growths of the bladder account for approximately 2% of bladder malignancies [1]. Bladder involvement in patients with primary colorectal adenocarcinomas is most likely to be secondary to direct invasion from the adjacent recto-sigmoid. Isolated distant metastases to the bladder from colorectal primary disease have very rarely been reported [2-5]. This case presents a case of frank haematuria related to a bladder metastasis from a mucinous adenocarcinoma of the caecum.A 45-year-old man presented with vague abdominal pain associated with a palpable mass. An ultrasound scan demonstrated a mass in the right iliac fossa but no evidence of hepatic metastases or lymphadenopathy. A plain X-ray film of the chest demonstrated no abnormality. A subsequent barium enema suggested a caecal carcinoma and he was subsequently treated for a pT3 N0 M0 (Dukes B) moderately differentiated mucinous adenocarcinoma of the caecum in July 2002 with a laparoscopically-assisted right hemicolectomy. A complete oncological resection was achieved with clear surgical resection margins of at least 4 centimetres. Fourte
Total bladder replacement with de-epithelialized ileum: experimental study in dogs
Vilar, Fábio O.;Araújo, Luiz A. P. de;Lima, Salvador V.C.;
International braz j urol , 2004, DOI: 10.1590/S1677-55382004000300013
Abstract: objective: to assess the value of the silicone modeler in preventing graft retraction in dogs undergoing bladder replacement with de-epithelialized ileum. materials and methods: twelve female dogs underwent total cystectomy and bladder replacement by neobladder made of demucosalized ileal segment, comparing the group with modeler (group i) and the group without modeler (group ii). cystometry data, graft epithelization and radiological assessment (cystography and excretory urography) were analyzed. results: neobladder capacity, at 2 months, ranged from 50 to 250 ml (mean 191 ml) and from 5 to 60 ml (mean 22 ml) and at 6 months, from 60 to 270 ml (mean 202.5 ml) and from 5 to 75 ml (mean- 30.5 ml), respectively in groups i and ii, with a statistically significant difference between groups. after 30 days, postoperatively the presence of transitional epithelium was observed in all fragments obtained by biopsy. conclusion: the use of the intravesical silicone modeler prevented the retraction of the neobladder of de-epithelialized ileum.
Primary mucinous adenocarcinoma in a defunctionalized urinary bladder: a case report
Mary Taneous, Preetha Ramalingam, Donald G Mode, Jared G Heiner, Martha K Terris, Jeffrey R Lee
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-9306
Abstract: We report a 57-year-old Caucasian man presenting with penile discharge for 30 years following ileal conduit surgery for neurogenic bladder, and who was found to have primary mucinous adenocarcinoma of his defunctionalized bladder.Although urinary diversion without cystectomy is less common in current urologic practice, there are many patients with longstanding defunctionalized bladders. While there are no established surveillance protocols, defunctionalized bladder patients with urethral discharge should be evaluated.Primary adenocarcinoma of the urinary bladder accounts for approximately 0.5-2% of all bladder cancers [1]. Patients generally present with hematuria, dysuria, suprapubic pain, and, less commonly, mucusuria. The histologic appearance of bladder adenocarcinoma can be enteric, signet ring, mucinous, clear cell, hepatoid and mixed types. The differential diagnosis includes glandular differentiation of transitional cell carcinoma and direct extension or metastatic spread of adenocarcinoma arising primarily from the colon, prostate, appendix or endometrium.Predisposing factors for the development of primary adenocarcinoma of the bladder include schistosomiasis, exstrophy, persistent urachal remnants, and bladder augmentation by intestinal segments [1,2]. Concomitant cystitis glandularis occurs in the majority of cases, but is not considered a definitive precursor lesion since adenocarcinoma can develop in the absence of cystitis glandularis and only a small number of bladders with cystitis glandularis actually develop malignancies [2].The potential for adenocarcinoma to develop in the defunctionalized bladder that is left in-situ at the time of urinary diversion is rare [3-5]. We describe the fifth case of primary mucinous adenocarcinoma arising in a longstanding defunctionalized bladder.A 57-year-old Caucasian man presented with profuse blood-streaked mucous drainage from his penis. Past medical history was significant for T12 spinal cord injury secondary t
An Unusual Case of Synchronous Carcinoid of Ovary and Gall Bladder  [PDF]
Rupali Bassi,Raksha Arora,Sangeeta Bhasin,Nita Khurana
Case Reports in Obstetrics and Gynecology , 2013, DOI: 10.1155/2013/737016
Abstract: Multifocal carcinoid is a known phenomenon. We present a rare combination of an ovarian carcinoid synchronous with gallbladder carcinoid. This rare combination has not been reported so far. An asymptomatic 45-years-old perimenopausal lady was diagnosed to have a metastatic ovarian cancer, but on laparotomy she was found to have a primary synchronous metastatic gall bladder as well. On histopathological evaluation she was found to have two separate primary carcinoids. Subsequently the patient received chemotherapy and is completely asymptomatic on follow up. Further research needs to be undertaken and guidelines need to be formulated for management of these cases. 1. Introduction Carcinoid tumors are neuroendocrine tumors derived predominantly from the enterochromaffin or Kulchitsky cells [1]. Carcinoid tumors were first described as early as 1888 by Lubarsh, occurring in the small bowel [2, 3]. The overall incidence of carcinoids is estimated to be approximately 1 to 2/100000 individuals [4]. They may be found anywhere in the human body but have been described traditionally as originating from the foregut, midgut, or hindgut. Multifocal primary disease is rarely known to occur with carcinoids, although very few cases have been reported till date. Synchronous primary carcinoid tumors have been reported in about 0% to 3% of small bowel carcinoid, and it has been observed that a second primary malignancy occurs in 7% to 32% of cases [5]. We present a rare case of synchronous primary carcinoid in the ovary and gall bladder, which has not been reported so far. 2. Case 45-year-old para 4, living 4 presented to the outpatient department with chief complaints of a progressive abdominal distension over the last 5 months and amenorrhea since the 5 past 3 months. Apart from these the patient was completely asymptomatic. On examination the general condition of the patient was stable and abdominal examination revealed a soft cystic, nontender abdominopelvic lump, corresponding to 22-week uterine size. The gall bladder was also palpably enlarged in the right hypochondrium. On Speculum examination the cervix and vagina were healthy, and vaginal examination revealed bilateral nontender cystic masses with restricted mobility. Ultrasound showed a left ovarian cystic mass in the iliac region with the gall bladder showing a localized heterogeneous echogenic mass. There was minimal dilatation of the common bile duct. This was followed by a contrast enhanced computed tomography scan of the patient that showed a multiseptated mass with solid and cystic components in the
Metastatic Transitional Cell Carcinoma of the Bladder to the Testis: A Case Report  [PDF]
Gregory N. Kozak,Nicholas C. Field
Case Reports in Urology , 2012, DOI: 10.1155/2012/486245
Abstract: An 84-year-old gentleman presented with onset of gross hematuria in September 2010. Follow-up investigations revealed T1 superficially invasive, poorly differentiated, papillary urothelial carcinoma. He subsequently had GreenLight laser for BPH and bladder neck contracture on two occasions. He developed a right hydrocele 16 months after initial presentation and during his hydrocelectomy, a rock-hard right epididymis and testicle were discovered. Pathology revealed metastatic urothelial carcinoma replacing nearly the entire testis with lymphovascular invasion. 1. Introduction Bladder cancer is the 5th most commonly diagnosed cancer in the USA and the 2nd most common genitourinary cancer after prostate cancer [1, 2]. In Western countries, the major risk factors are environmental exposure such as smoking and occupational exposure to chemicals used in the dye, rubber, leather, and painting industries [3]. The most common symptoms of bladder cancer are painless hematuria, urgency, frequency, and irritation associated with voiding [3]. Histologically, bladder cancer is categorized into transitional cell carcinoma (90%), squamous cell carcinoma (5%), and adenocarcinoma (<2%) [2]. Non-invasive TCC is divided into papillary and flat. Noninvasive papillary TCC is subdivided into papilloma, papillary transitional cell neoplasm of low malignant potential, low grade carcinoma, and high grade carcinoma [2]. 2. Case Presentation An 84 year old gentleman presented to the Emergency Department with onset of gross hematuria in September 2010. Subsequent pelvic ultrasound revealed a 1.2 × 1.6 × 1.5?cm lesion on the anterior wall of the urinary bladder projecting into the lumen. Cystoscopy showed a small bladder tumor below the bladder neck and a larger tumor to the left of the original tumor. TURBT pathology indicated a T1 superficially invasive poorly differentiated papillary urothelial carcinoma, focally invasive into the lamina propria, but not the muscularis propria. No CIS was noted. TURP pathology indicated inflammatory tissue consistent with previous infection of the prostate. Follow-up cystoscopy in January 2011, showed no evidence of recurrent tumor and the patient was scheduled to start BCG therapy. On repeat cystoscopy in May 2011, a bladder neck contracture was noted. GreenLight Laser for BPH and bladder neck contracture was performed in June 2011. During follow up cystoscopy in November 2011, an additional bladder neck contracture was identified and this was subsequently treated with GreenLight laser in December 2011. Prior to the second GreenLight laser
Urethral substitution with ileum in traumatic bladder neck-vagina fistula
Kannaiyan Lavanya,Sen Sudipta
Journal of Indian Association of Pediatric Surgeons , 2009,
Abstract: A five-year-old girl presented with post traumatic urinary incontinence secondary to rupture of the bladder neck into the vagina. Operative repair included a midline exposure with resection of the symphysis pubis, separation of the bladder neck from the vagina, repair of the torn bladder neck and urethral substitution with ileum. Normal continence and voiding was achieved.
Intramucosal adenocarcinoma of the ileum originated 40 years after ileosigmoidostomy
Shinichi Sameshima, Shigeru Tomozawa, Shinichiro Koketsu, Toshiyuki Okada, Hideyo Miyato, Misa Iijima, Masaru Kojima, Toshio Kaji
World Journal of Surgical Oncology , 2009, DOI: 10.1186/1477-7819-7-41
Abstract: A 72-year-old Japanese male had a positive fecal occult blood test at a regular check-up in 2006. He suffered appendicitis and received an ileosigmoidostomy in 1966. A colonoscopy revealed an irregular mucosal lesion with an unclear margin at the ileum side of the anastomosis. A mucosal biopsy specimen showed adenocarcinoma histopathologically. Excision of the anastomosis was performed for this patient. The resected specimen showed a flat mucosal lesion with a slight depression at the ileum adjacent to the anastomosis. Histological examination revealed a well differentiated intramucosal adenocarcinoma (adenocarcinoma in situ). Immunohistological staining demonstrated the overexpression of p53 protein in the adenocarcinoma.Adenocarcinoma of the ileum at such an early stage is a very rare event. In this case, there is a possibility that the ileosigmoidostomy resulted in a back flow of colonic stool to the ileum that caused the carcinogenesis of the small intestine.Small bowel adenocarcinomas (SBAs) are rare carcinomas. They are asymptomatic and usually neither endoscopy nor contrast studies are performed for screening. Most of SBAs are detected at the advanced stage. Early stage SBAs are extremely rare cases.We report a case of an intramucosal adenocarcinoma (adenocarcinoma in situ) of the ileum mucosa an ileosigmoidostomy. A few cases with adenocarcinoma in situ of small bowel have been reported [1]. There is no report of an adenocarcinoma of the ileum following the ileocolonostomy in the literature.A Japanese male suffered severe appendicitis and received an ileosigmoidostomy without appendectomy in 1966. A prostatectomy was performed for benign prostate hypertrophy at the age of 67. He also received medical treatment for hypertension. A regular check-up in August 2006, when the patient was 72 years of age, revealed a positive fecal occult blood test. A colonoscopy was conducted by his family practitioner and an irregular mucosal lesion with an unclear margin was de
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